Improved Tissue Processing in Esophageal Adenocarcinoma After Ivor Lewis Esophagectomy Allows Histological Analysis of A
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ORIGINAL ARTICLE – THORACIC ONCOLOGY
Improved Tissue Processing in Esophageal Adenocarcinoma After Ivor Lewis Esophagectomy Allows Histological Analysis of All Surgically Removed Lymph Nodes with Significant Effects on Nodal UICC Stages A. Quaas, MD1, H. Schloesser2, H. Fuchs2, T. Zander3, C. Arolt1, A. H. Scheel1, J. Rueschoff4, C. Bruns2, R. Buettner1, and W. Schroeder2 1
Institute of Pathology, Gastrointestinal Cancer Group Cologne (GCGC), University Hospital Cologne, Cologne, Germany; Department of General, Visceral, Cancer and Transplantation Surgery, University Hospital Cologne, Cologne, Germany; 3 Department of Internal Medicine I, University Hospital Cologne, Cologne, Germany; 4Institute of Pathology, Nordhessen and Targos Molecular Pathology GmbH, Kassel, Germany 2
ABSTRACT Background. In esophageal carcinoma, the numbers of metastatic and total removed lymph nodes (LN) are wellestablished variables of long-term prognosis. The overall rate of retrieved LN depends on neoadjuvant treatment, the extent of surgical lymphadenectomy, and the modality of the pathological workup. The question in this study is whether technically extended histopathological preparation can increase the number of detected (metastatic) LN with an impact on nodal UICC staging. Patients and Methods. A cohort of 77 patients with esophageal adenocarcinoma was treated with Ivor Lewis esophagectomy including standardized two-field lymphadenectomy. The specimens were grossed, and all manually detectable LN were retrieved. The remaining tissue was completely embedded by the advanced ‘‘acetone compression’’ retrieval technique. The primary outcome
parameter was the total number of detected lymph nodes before and after acetone workup. Results. A mean number of 23,1 LN was diagnosed after standard manual LN preparation. With complete embedding of the fatty tissue using acetone compression, the number increased to 40.5 lymph nodes (p \ 0.0001). The mean number of metastatic LN increased from 3.2 to 4.2 nodal metastases following acetone compression (p \ 0.0001). Additional LN metastases which caused a change in the primary (y)pN stage were found in ten patients (13.0%). Conclusions. Advanced lymph node retrieval by acetone compression allows a reliable statement on the real number of removed LN. Results demonstrate an impact on the nodal UICC stage. A future multicenter study will examine the prognostic impact of improved lymph node retrieval on long-term oncologic outcome. Keywords Lymph nodes Acetone compression Esophageal adenocarcinoma Esophagectomy UICC stage
Supplementary Information The online version of this article contains supplementary material available at https://doi.org/10.1245/ s10434-020-09450-1. Ó The Author(s) 2020 First Received: 4 September 2020 Accepted: 16 November 2020 A. Quaas, MD e-mail: [email protected]; [email protected]
Multimodal treatment including transthoracic esophagectomy is generally accepted as standard care for patients with locally advanced but curable esophageal carcinoma.1 Howe
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