Lymphadenectomy and Survival After Neoadjuvant Chemoradiation for Esophageal Adenocarcinoma: Is More Better?
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SSAT PLENARY PRESENTATION
Lymphadenectomy and Survival After Neoadjuvant Chemoradiation for Esophageal Adenocarcinoma: Is More Better? Susanna W. L. de Geus 1 & Sameer Hirji 2 & Krista J. Hachey 1 & Teviah E. Sachs 1 & Kei Suzuki 1 & Sing Chau Ng 1 & Scott Swanson 2 & Virginia R. Litle 1 & Thomas D’Amico 3 & Jennifer F. Tseng 1 Received: 1 June 2019 / Accepted: 16 July 2020 # 2020 The Society for Surgery of the Alimentary Tract
Abstract Purpose The purpose of this study was to assess the impact of number of lymph nodes examined on survival in patients with esophageal adenocarcinoma who underwent neoadjuvant chemoradiation. Methods The National Cancer Database was queried for patients who underwent neoadjuvant chemoradiation followed by surgery for esophageal adenocarcinoma. Propensity scores were created predicting the odds of undergoing resection of ≥ 25 nodes. Patients were matched on propensity score. Overall survival analyses were performed using the Kaplan-Meier method. Sensitivity analyses were performed using various nodal cutoffs. Results In total, 3953 patients who underwent neoadjuvant chemoradiation were identified. The median number of resected nodes was 14 nodes (IQR, 8–20 nodes). Resection of ≥ 15 (vs. < 15 nodes: 32 vs. 26 months; p < 0.001), ≥ 20 (vs. < 20 nodes: 36 vs. 28 months; p = 0.001), and ≥ 25 (vs. < 25 nodes: 37 vs. 29 months; p = 0.015) nodes was associated with higher median survival, but resection of ≥ 30 nodes was not (vs. < 30 nodes: 41 vs. 33 months; p = 0.367). Resection of ≥ 25 lymph nodes remained predictive for improved survival on subset analysis in patients with negative nodes and who underwent treatment at high-volume centers. Conclusions After neoadjuvant chemoradiation, resection of 25 or more lymph nodes was associated with longer median survival. Prospective trials are warranted to determine the optimal nodal yield after neoadjuvant chemoradiation. Keywords Esophageal cancer . Ssophageal adenocarcinoma . Extended lymphadenectomy . Lymph nodes . Neoadjuvant therapy . Neoadjuvant chemoradiation . Staging . Survival
Introduction Esophageal cancer currently ranks as the sixth most common cause among cancer-related deaths globally, with an estimated
Previous communication: Presented as an oral presentation during the 34th Annual Surgery of the Alimentary Tract (SSAT) Residents and Fellows Research Conference, San Diego, California, May 2019. * Jennifer F. Tseng [email protected] 1
Department of Surgery, Boston Medical Center, Boston University School of Medicine, 88 East Newton Street, Collamore C500, Boston, MA 02118, USA
2
Department of Surgery, Brigham and Women’s Hospital, Harvard Medical School, Boston, MA, USA
3
Department of Surgery, Duke University Medical Center, Durham, NC, USA
5-year survival of less than 20%.1 The National Comprehensive Cancer Network recommends extensive lymphadenectomy of at least 15 lymph nodes during upfront esophagectomy, with several studies demonstrating survival benefit with resection of up to 30 lymph nodes.2–5 Extensive lymph
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