Lymph node retrieval during esophagectomy with and without neoadjuvant chemoradiotherapy: prognostic and therapeutic impact on survival.
OBJECTIVE
We aimed to examine the association between total number of resected nodes and survival in patients after esophagectomy with and without nCRT.


BACKGROUND
Most studies concerning the potentially positive effect of extended lymphadenectomy on survival have been performed in patients who underwent surgery alone. As nCRT is known to frequently "sterilize" regional nodes, it is unclear whether extended lymphadenectomy after nCRT is still useful.


METHODS
Patients from the randomized CROSS-trial who completed the entire protocol (ie, surgery alone or chemoradiotherapy + surgery) were included. With Cox regression models, we compared the impact of number of resected nodes as well as resected positive nodes on survival in both groups.


RESULTS
One hundred sixty-one patients underwent surgery alone, and 159 patients received multimodality treatment. The median (interquartile range) number of resected nodes was 18 (12-27) and 14 (9-21), with 2 (1-6) and 0 (0-1) resected positive nodes, respectively. Persistent lymph node positivity after nCRT had a greater negative prognostic impact on survival as compared with lymph node positivity after surgery alone. The total number of resected nodes was significantly associated with survival for patients in the surgery-alone arm (hazard ratio per 10 additionally resected nodes, 0.76; P=0.007), but not in the multimodality arm (hazard ratio 1.00; P=0.98).


CONCLUSIONS
The number of resected nodes had a prognostic impact on survival in patients after surgery alone, but its therapeutic value is still controversial. After nCRT, the number of resected nodes was not associated with survival. These data question the indication for maximization of lymphadenectomy after nCRT.
Departments of *Surgery †Public Health ‡Medical Oncology, Erasmus MC - University Medical Center, Rotterdam, The Netherlands §Department of Surgery, Academic Medical Center, Amsterdam, The Netherlands.
A
A
Koen Talsma
Joel
J
Shapiro
Caspar W N
CW
Looman
Pieter
P
van Hagen
Ewout W
EW
Steyerberg
Ate
A
van der Gaast
Mark I
MI
van Berge Henegouwen
Bas P L
BP
Wijnhoven
J Jan B
JJ
van Lanschot
Maarten C C M
MC
Hulshof
Hanneke W M
HW
van Laarhoven
Grard A P
GA
Nieuwenhuijzen
Geke A P
GA
Hospers
Johannes J
JJ
Bonenkamp
Miguel A
MA
Cuesta
Reinoud J B
RJ
Blaisse
Olivier R C
OR
Busch
Fiebo J W
FJ
ten Kate
Geert-Jan
GJ
Creemers
Cornelis J A
CJ
Punt
John T M
JT
Plukker
Henk M W
HM
Verheul
Herman
H
van Dekken
Maurice J C
MJ
van der Sangen
Tom
T
Rozema
Katharina
K
Biermann
Jannet C
JC
Beukema
Anna H M
AH
Piet
Caroline M
CM
van Rij
Janny G
JG
Reinders
Hugo W
HW
Tilanus
D000368:Aged; D000971:Antineoplastic Combined Chemotherapy Protocols / Q000627:therapeutic use; D059248:Chemoradiotherapy; D004938:Esophageal Neoplasms / Q000473:pathology / Q000628:therapy*; D016629:Esophagectomy; D005260:Female; D006801:Humans; D008197:Lymph Node Excision; D008207:Lymphatic Metastasis; D008297:Male; D008875:Middle Aged; D020360:Neoadjuvant Therapy; D009367:Neoplasm Staging; D011379:Prognosis; D015996:Survival Rate; D016896:Treatment Outcome