ASO Author Reflections: Lymph Node Metastasis of Esophageal Cancer After Trimodal Therapy
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ASO AUTHOR REFLECTIONS
ASO Author Reflections: Lymph Node Metastasis of Esophageal Cancer After Trimodal Therapy Yoichi Hamai, MD, PhD Department of Surgical Oncology, Hiroshima University, Hiroshima, Japan
PAST The frequency of lymph node metastasis (LNM) is high in the early stages of esophageal cancer. Thus, pathological LNM is prevalent in patients with locally advanced esophageal cancer, even after neoadjuvant chemoradiotherapy (NCRT) followed by surgery. Pathological LNM is closely associated with prognosis after trimodal therapy.1–4 Although NCRT would arguably affect metastatic tumors in LNs, the distribution of LNM of esophageal squamous cell carcinoma (ESCC) after trimodal therapy has never been absolutely determined. PRESENT We evaluated the distribution of LNM and the influence of LNM on survival in 184 consecutive patients with ESCC who underwent NCRT followed by surgery.5 Pathological LNM was extensive in 177 LN stations in the cervical, mediastinal, and abdominal fields, and 162 (91.5%) metastases were located inside the radiation fields. Clinical N stage and clinical response of the primary tumor were statistically significant for pathological LNM. Survival was significantly stratified according to the number of pathological LNMs, associations between clinical and pathological LNMs, and the presence or absence of pathological LNM outside the radiation field. Many patients had LNM even within the radiation field, as well as widespread LNM in the cervical, mediastinal, and
Ó Society of Surgical Oncology 2020 First Received: 27 August 2020 Accepted: 28 August 2020 Y. Hamai, MD, PhD e-mail: [email protected]
abdominal fields. Thus, concurrent systematic and sufficient lymphadenectomy should be conducted during esophageal surgery, even after NCRT for locally advanced ESCC. FUTURE Esophageal cancer with pathological LNM after trimodal therapy is likely to be extremely proliferative and have metastatic potential as well as resistance to NCRT, especially when metastases are identified in LNs located far from the radiation field. Therefore, postoperative adjuvant therapy should be carefully considered for patients with metastases in resected LNs to delay and decrease the likelihood of recurrence after trimodal therapy. Furthermore, the extent of lymphadenectomy should be determined considering the effects of LN resection on prognosis based on the distribution of LNM in ESCC treated by trimodal therapy. Further improvements in preoperative diagnoses of LNM, further studies of esophageal surgery with optimal lymphadenectomy according to the distribution of LNM, and further studies regarding prognosis are needed in the future for ESCC treated with NCRT. DISCLOSURES disclose.
Yoichi Hamai has no conflicts of interest to
REFERENCES 1. Hamai Y, Hihara J, Emi M, et al. Evaluation of prognostic factors for esophageal squamous cell carcinoma treated with neoadjuvant chemoradiotherapy followed by surgery. World J Surg. 2018;42:1496–1505. 2. Hamai Y, Emi M, Ibuki Y, et al. Early recurrence and cancer death afte
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