title: Preoperative chemoradiation therapy decreases the number of lymph nodes resected during esophagectomy.
abstract: BACKGROUND
  This study aimed to analyze the effect of preoperative chemoradiation on the adequacy of lymph node dissection.
  
  
  METHODS
  Patients with esophageal cancer treated with esophagectomy by the same surgeon between 2004 and 2011 were reviewed. Specimens were examined by the same pathologist. Patients were grouped into two depending on the type of treatment received.
  
  
  RESULTS
  Forty-seven patients with curative esophagectomy were included in the study. Twenty patients had preoperative chemoradiation followed by surgery and 27 had surgery alone. Open and hybrid esophagectomy approaches were used. The average number of lymph nodes dissected was 16 ± 10 (1-39). There was a significant decrease in the number of lymph nodes examined in patients with preoperative chemoradiotherapy in comparison to surgery alone (p = 0.001). Median length of stay was 12 days. R0 resection rate was 96%. The median survival was 36.3 months, with a 42% 5-year survival. Seven patients (25%) had complete pathologic response following chemoradiation. No significant difference was recorded in terms of disease recurrence (p = 0.3). While morbidity was higher in the preoperative therapy group with 30 day mortality of 10%, type of surgical approach does not seem to influence the number of lymph nodes dissected (p = 0.7).
  
  
  CONCLUSIONS
  Preoperative chemoradiation decreases the number of harvested lymph nodes following esophagectomy regardless of the surgical technique used. The optimum number of lymph nodes currently recommended to be dissected for accurate nodal staging and survival needs revision in this group of patients.
authors.affiliation: Department of Thoracic Surgery, Marmara University Medical Faculty Hospital, 7th Floor. Fevzi Cakmak Mahallesi, Mimar Sinan Caddesi No: 41, Ust Kaynarca, Pendik, 34899, Istanbul, Turkey.
authors.forename: Adamu
authors.initials: A
authors.lastname: Issaka
authors.forename: Nezih Onur
authors.initials: NO
authors.lastname: Ermerak
authors.forename: Zeynep
authors.initials: Z
authors.lastname: Bilgi
authors.forename: Volkan Hasan
authors.initials: VH
authors.lastname: Kara
authors.forename: Cigdem Ataizi
authors.initials: CA
authors.lastname: Celikel
authors.forename: Hasan Fevzi
authors.initials: HF
authors.lastname: Batirel
mesh_terms: D000230:Adenocarcinoma / Q000628:therapy*; D000971:Antineoplastic Combined Chemotherapy Protocols / Q000627:therapeutic use*; D002294:Carcinoma, Squamous Cell / Q000628:therapy*; D059186:Chemoradiotherapy, Adjuvant / Q000009:adverse effects; D002945:Cisplatin / Q000008:administration & dosage; D019583:Dose Fractionation, Radiation; D004938:Esophageal Neoplasms / Q000628:therapy*; D016629:Esophagectomy / Q000009:adverse effects / Q000379:methods*; D005260:Female; D006801:Humans; D007902:Length of Stay; D008197:Lymph Node Excision / Q000009:adverse effects; D008198:Lymph Nodes; D008297:Male; D008875:Middle Aged; D020360:Neoadjuvant Therapy / Q000009:adverse effects; D018365:Neoplasm, Residual; D012189:Retrospective Studies; D015996:Survival Rate; D005641:Tegafur / Q000008:administration & dosage
chemical_list: D005641:Tegafur; D002945:Cisplatin