Lymph node analysis in esophageal resection: American College of Surgeons Oncology Group Z0060 trial.
BACKGROUND
The American Joint Committee on Cancer staging of esophageal cancer has been criticized for not establishing a minimum standard for lymphadenectomy, and for relying on location of nodes involved rather than their number. The objective of this study was to review the current practice of American surgeons with regard to lymph node assessment during esophageal resection.


METHODS
The operative and pathology reports of patients who underwent staging by computed tomography and fluorodeoxyglucose-positron emission tomography and subsequent resection for esophageal cancer (multiinstitutional American College of Surgeons Oncology Group Z0060 trial) were analyzed.


RESULTS
One hundred forty-five patients underwent resection. Operative and pathology reports were unavailable in 11 patients. The results of the remaining 134 resections (Ivor-Lewis, n = 64; transhiatal, n = 59; other, n = 11) were reviewed. Overall, 13 +/- 9 (mean +/- standard deviation) lymph nodes were evaluated per patient. More lymph nodes were evaluated in patients undergoing Ivor-Lewis (15 +/- 9) than transhiatal esophagectomy (9 +/- 7; p < 0.001). The mean number of distinct lymph node stations analyzed per patient was 3 +/- 2. In 38% (51 of 134) of patients the nodes attached to the specimen were evaluated without any distinction among nodal stations. The practice of submitting named packets of nodal material resulted in 16 +/- 9 nodes per case, as opposed to the practice of submitting an entire specimen for the pathologists to dissect, which yielded 10 +/- 8 nodes (p < 0.001).


CONCLUSIONS
There is considerable variability and room to improve in the extent of resection and pathologic evaluation of esophagectomy specimens. A uniform standard for esophageal cancer resection is warranted to improve the precision and value of pathologic staging.
Veeramachaneni
Nirmal K
NK
Division of Cardiothoracic Surgery, Washington University School of Medicine, St Louis, Missouri 63110, USA.
Zoole
Jennifer B
JB
Decker
Paul A
PA
Putnam
Joe B
JB
Meyers
Bryan F
BF
D000230:Adenocarcinoma / Q000473:pathology* / Q000601:surgery; D002294:Carcinoma, Squamous Cell / Q000473:pathology* / Q000601:surgery; D004938:Esophageal Neoplasms / Q000175:diagnosis / Q000473:pathology* / Q000601:surgery; D016629:Esophagectomy / Q000592:standards*; D004943:Esophagogastric Junction / Q000473:pathology*; D019788:Fluorodeoxyglucose F18; D006801:Humans; D008197:Lymph Node Excision / Q000592:standards*; D008198:Lymph Nodes / Q000473:pathology; D009367:Neoplasm Staging; D049268:Positron-Emission Tomography / Q000706:statistics & numerical data; D019275:Radiopharmaceuticals; D014057:Tomography, X-Ray Computed
D019275:Radiopharmaceuticals; D019788:Fluorodeoxyglucose F18