The Value of Lymphadenectomy Post-Neoadjuvant Therapy in Carcinoma Esophagus: a Review
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REVIEW ARTICLE
The Value of Lymphadenectomy Post-Neoadjuvant Therapy in Carcinoma Esophagus: a Review Syed Nusrath 1 & Ajesh Raj Saxena 1 & K. V. V. N. Raju 1 & Sujith Patnaik 1 & T. Subramanyeshwar Rao 1 & Naren Bollineni 1 Received: 19 February 2020 / Accepted: 30 June 2020 # Indian Association of Surgical Oncology 2020
Abstract Lymph nodal metastasis is one of the most important prognostic factors determining survival in patients with carcinoma esophagus. Radical esophagectomy, with the resection of surrounding lymph nodes, is considered the prime treatment of carcinoma esophagus. An extensive lymphadenectomy improves the accuracy of staging and betters locoregional control, but its effect on survival is still not apparent and carries the disadvantage of increased morbidity. The extent of lymphadenectomy during esophagectomy also remains debatable, with many studies revealing contradictory results, especially in the era of neoadjuvant therapy. The pattern of distribution and the number of nodal metastasis are modified by neoadjuvant therapy. The paper reviews the existing evidence to determine whether increased lymph node yield improves oncological outcomes in patients undergoing esophagectomy with particular attention to those patients receiving neoadjuvant therapy. Keywords Lymphadenectomy . Esophagectomy . Neoadjuvant therapy
Introduction Esophageal cancer is the eighth most common cancer with an annual incidence of 572,000 new cases, constituting 3.2% of all cases globally and the seventh leading cause of cancerrelated death with 500,000 death annually [1]. Esophageal cancer is an aggressive cancer with early lymphatic dissemination to the neck, chest, and abdomen. Traditionally, the prognosis of patients with esophageal cancer has remained
* Syed Nusrath [email protected] Ajesh Raj Saxena [email protected] K. V. V. N. Raju [email protected] Sujith Patnaik [email protected] T. Subramanyeshwar Rao [email protected] Naren Bollineni [email protected] 1
Department of Surgical Oncology, Basavatarakam Indo American Cancer Hospital and Research Institute, Hyderabad, India
dismal, especially in the presence of lymph node metastases. Esophagectomy is considered a prime modality of treatment but carries high morbidity and mortality. However, operative mortality for esophagectomy has significantly declined to less than 5% in high-volume centers [2–4], owing to better postoperative care, better surgical skills, usage of minimally invasive surgery, and the introduction of neoadjuvant therapy. With declining operative mortality, the primary focus has been switched to prolonging long-term survival. En bloc resection principles have been applied to esophageal surgery for prolonging survival [2]. Since the extent of lymphadenectomy and removal of the primary tumor is a factor modifiable by the surgeon, the emphasis of treatment is tilted towards exploring the role of extended lymphadenectomy. Nonetheless, the efficacy of en bloc resection and the extended nodal dissection is yet to be p
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