title: Transthoracic esophagectomy for adenocarcinoma of the oesophagus: standard versus extended two-field mediastinal lymphadenectomy?
abstract: OBJECTIVE
  Controversy continues over the optimal extent of lymphadenectomy for the surgical treatment of Adenocarcinoma of the oesophagus.
  
  
  METHODS
  From 1996 to 2003, 102 transthoracic en-bloc esophagectomy were performed for adenocarcinoma. Based on the 1994 consensus conference of the International Society of Disease of Esophagus, 35 patients underwent standard lymphadenectomy whereas 67 underwent extended lymphadenectomy. Mortality, morbidity and long-term survival were reviewed in each group.
  
  
  RESULTS
  Extended lymphadenectomy increased the number of resected lymph nodes and improved the healthy/invaded lymph node ratio. It allowed to detect skip nodal metastasis in 36.4% of the N+ patients. Morbidity was higher following extended lymphadenectomy, with respect to pulmonary complications, and blood transfusions requirement (P=0.04). However, operative mortality was similar in both groups (9 vs. 11%). Overall disease-free survival was 28% at 5 years. Median of survival was higher in N0 than in N+ patients (55 months vs. 20 months; P=0.02). Extended lymphadenectomy was associated with an improving of disease-free survival when compared to standard lymphadenectomy (41 vs. 10% at 5 years; P<0.05), especially in the subgroup of patients with a N0 disease (median of survival 44 months vs. 17 months; P=0.001). Based on multivariable analyses, predictive factors of recurrence affecting disease free-survival were the pT status (P=0.02), standard lymphadenectomy (P=0.05) and extracapsular lymph node involvement (0.04).
  
  
  CONCLUSIONS
  These results indicate that extended 2-field lymphadenectomy is an important component of the surgical treatment of patients with adenocarcinoma of the oesophagus. It increases the likelihood of proper staging and affects patient outcome, while it does not enhance the operative mortality. However, extended lymphadenectomy increases non-fatal morbidity, especially the incidence of pulmonary complications and the need for blood transfusion.
authors.affiliation: Department of Thoracic Surgery Ste Marguerite University Hospital, CHU Sud, 270 Bd Ste Marguerite, 13274 Marseille, Cedex 9, France.
authors.forename: Xavier Benoît
authors.initials: XB
authors.lastname: D'Journo
authors.forename: Christophe
authors.initials: C
authors.lastname: Doddoli
authors.forename: Pierre
authors.initials: P
authors.lastname: Michelet
authors.forename: Anderson
authors.initials: A
authors.lastname: Loundou
authors.forename: Delphine
authors.initials: D
authors.lastname: Trousse
authors.forename: Roger
authors.initials: R
authors.lastname: Giudicelli
authors.forename: Pierre Antoine
authors.initials: PA
authors.lastname: Fuentes
authors.forename: Pascal Alexandre
authors.initials: PA
authors.lastname: Thomas
mesh_terms: D000230:Adenocarcinoma / Q000473:pathology / Q000556:secondary / Q000601:surgery*; D000368:Aged; D004812:Epidemiologic Methods; D004938:Esophageal Neoplasms / Q000473:pathology / Q000601:surgery*; D016629:Esophagectomy / Q000379:methods*; D005260:Female; D006801:Humans; D008197:Lymph Node Excision / Q000009:adverse effects / Q000379:methods*; D008207:Lymphatic Metastasis; D008297:Male; D008875:Middle Aged; D009367:Neoplasm Staging; D012008:Recurrence; D012120:Respiration Disorders / Q000209:etiology; D016896:Treatment Outcome