title: Effectiveness of radical en-bloc-esophagectomy compared to transhiatal esophagectomy in squamous cell cancer of the esophagus is influenced by nodal micrometastases.
abstract: OBJECTIVE
  The appropriate surgery for curable squamous cell cancer (SCC) of the esophagus is discussed controversially.
  
  
  METHODS
  Transthoracic esophagectomy (TTE) with radical en-bloc-lymphadenectomy was performed in 79/120 patients (66%). Due to severe comorbidity, 41/120 patients (34%) underwent less traumatizing transhiatal esophagectomy. Lymph nodes were stained using mAb BER-Ep4.
  
  
  RESULTS
  pN0 status was found in 54 patients (45%) and pN1 status in 66 patients (55%). In the pN0 subgroup, 30 out of 54 patients (55.6%) had occult tumor cells in lymph nodes detected with BER-Ep4. pN1 patients had additional BER-Ep4 positive cells in histopathologically negative lymph nodes in 41 out of 66 patients (59.2%). Median disease-specific survival was 31.4 and 16.8 months for the transthoracic and transhiatal groups, respectively (P = 0.129). pN0 patients lived longer after transthoracic resection (P = 0.0349), and in the subgroup without lymph node micrometastases this effect was even stronger (P = 0.025). In contrast, in pN0 patients with nodal microinvolvement, TTE did not entail a survival benefit when compared with the transhiatal group (P = 0.333).
  
  
  CONCLUSIONS
  TTE results in improved outcome in the absence of lymph node micrometastases. Poor survival in patients with lymphatic micro-dissemination indicates systemic disease and the need for adjuvant treatment.
authors.affiliation: Department of General, Visceral and Thoracic Surgery at the University Medical Center Hamburg-Eppendorf, University of Hamburg, Hamburg, Germany.
authors.forename: Emre F
authors.initials: EF
authors.lastname: Yekebas
authors.forename: Paulus G
authors.initials: PG
authors.lastname: Schurr
authors.forename: Jussuf T
authors.initials: JT
authors.lastname: Kaifi
authors.forename: Bjoern C
authors.initials: BC
authors.lastname: Link
authors.forename: Asad
authors.initials: A
authors.lastname: Kutup
authors.forename: Oliver
authors.initials: O
authors.lastname: Mann
authors.forename: Lars
authors.initials: L
authors.lastname: Wolfram
authors.forename: Jakob R
authors.initials: JR
authors.lastname: Izbicki
mesh_terms: D000328:Adult; D000368:Aged; D002294:Carcinoma, Squamous Cell / Q000556:secondary / Q000601:surgery*; D004938:Esophageal Neoplasms / Q000473:pathology / Q000601:surgery*; D016629:Esophagectomy / Q000379:methods* / Q000401:mortality; D005260:Female; D006801:Humans; D008197:Lymph Node Excision / Q000706:statistics & numerical data; D008198:Lymph Nodes / Q000473:pathology*; D008207:Lymphatic Metastasis; D008297:Male; D008875:Middle Aged; D016019:Survival Analysis; D016896:Treatment Outcome