Extent of Lymphadenectomy and Long-Term Survival in Esophageal Cancer
(2023) In Annals of Surgery 277(3). p.429-436- Abstract
OBJECTIVE: To examine the hypothesis that survival in esophageal cancer increases with more removed lymph nodes during esophagectomy up to a plateau, after which it levels out or even decreases with further lymphadenectomy.
SUMMARY BACKGROUND DATA: There is uncertainty regarding the ideal extent of lymphadenectomy during esophagectomy to optimize long-term survival in esophageal cancer.
METHODS: This population-based cohort study included almost every patient who underwent esophagectomy for esophageal cancer in Sweden or Finland in 2000-2016 with follow-up through 2019. Degree of lymphadenectomy, divided into deciles, was analyzed in relation to all-cause 5-year mortality. Multivariable Cox regression provided hazard ratios... (More)
OBJECTIVE: To examine the hypothesis that survival in esophageal cancer increases with more removed lymph nodes during esophagectomy up to a plateau, after which it levels out or even decreases with further lymphadenectomy.
SUMMARY BACKGROUND DATA: There is uncertainty regarding the ideal extent of lymphadenectomy during esophagectomy to optimize long-term survival in esophageal cancer.
METHODS: This population-based cohort study included almost every patient who underwent esophagectomy for esophageal cancer in Sweden or Finland in 2000-2016 with follow-up through 2019. Degree of lymphadenectomy, divided into deciles, was analyzed in relation to all-cause 5-year mortality. Multivariable Cox regression provided hazard ratios (HR) with 95% confidence intervals (95% CI) adjusted for all established prognostic factors.
RESULTS: Among 2,306 patients, the 2nd (4-8 nodes), 7th (21-24 nodes) and 8th decile (25-30 nodes) of lymphadenectomy showed the lowest all-cause 5-year mortality compared to the 1st decile (HR = 0.77, 95% CI 0.61-0.97, HR = 0.76, 95% CI 0.59-0.99, and HR = 0.73, 95% CI 0.57-0.93, respectively). In stratified analyses, the survival benefit was greatest in decile 7 for patients with pathological T-stage T3/T4 (HR = 0.56, 95% CI 0.40-0.78), although it was statistically improved in all deciles except decile 10. For patients without neoadjuvant chemotherapy, survival was greatest in decile 7 (HR = 0.60, 95% CI 0.41-0.86), although survival was also statistically significantly improved in deciles 2, 6, and 8.
CONCLUSION: Survival in esophageal cancer was not improved by extensive lymphadenectomy, but resection of a moderate number (20-30) of nodes was prognostically beneficial for patients with advanced T-stages (T3/T4) and those not receiving neoadjuvant therapy.
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- author
- Gottlieb-Vedi, Eivind ; Kauppila, Joonas H ; Mattsson, Fredrik LU ; Hedberg, Jakob ; Johansson, Jan LU ; Edholm, David ; Lagergren, Pernilla ; Nilsson, Magnus and Lagergren, Jesper
- organization
- publishing date
- 2023-03
- type
- Contribution to journal
- publication status
- published
- subject
- in
- Annals of Surgery
- volume
- 277
- issue
- 3
- pages
- 8 pages
- publisher
- Lippincott Williams & Wilkins
- external identifiers
-
- scopus:85147536361
- pmid:34183514
- ISSN
- 1528-1140
- DOI
- 10.1097/SLA.0000000000005028
- language
- English
- LU publication?
- yes
- additional info
- Copyright © 2021 Wolters Kluwer Health, Inc. All rights reserved.
- id
- bca605e0-6a2e-454a-b63d-f5370f01b59a
- date added to LUP
- 2022-05-31 16:18:18
- date last changed
- 2024-04-18 05:29:08
@article{bca605e0-6a2e-454a-b63d-f5370f01b59a,
abstract = {{<p>OBJECTIVE: To examine the hypothesis that survival in esophageal cancer increases with more removed lymph nodes during esophagectomy up to a plateau, after which it levels out or even decreases with further lymphadenectomy.</p><p>SUMMARY BACKGROUND DATA: There is uncertainty regarding the ideal extent of lymphadenectomy during esophagectomy to optimize long-term survival in esophageal cancer.</p><p>METHODS: This population-based cohort study included almost every patient who underwent esophagectomy for esophageal cancer in Sweden or Finland in 2000-2016 with follow-up through 2019. Degree of lymphadenectomy, divided into deciles, was analyzed in relation to all-cause 5-year mortality. Multivariable Cox regression provided hazard ratios (HR) with 95% confidence intervals (95% CI) adjusted for all established prognostic factors.</p><p>RESULTS: Among 2,306 patients, the 2nd (4-8 nodes), 7th (21-24 nodes) and 8th decile (25-30 nodes) of lymphadenectomy showed the lowest all-cause 5-year mortality compared to the 1st decile (HR = 0.77, 95% CI 0.61-0.97, HR = 0.76, 95% CI 0.59-0.99, and HR = 0.73, 95% CI 0.57-0.93, respectively). In stratified analyses, the survival benefit was greatest in decile 7 for patients with pathological T-stage T3/T4 (HR = 0.56, 95% CI 0.40-0.78), although it was statistically improved in all deciles except decile 10. For patients without neoadjuvant chemotherapy, survival was greatest in decile 7 (HR = 0.60, 95% CI 0.41-0.86), although survival was also statistically significantly improved in deciles 2, 6, and 8.</p><p>CONCLUSION: Survival in esophageal cancer was not improved by extensive lymphadenectomy, but resection of a moderate number (20-30) of nodes was prognostically beneficial for patients with advanced T-stages (T3/T4) and those not receiving neoadjuvant therapy.</p>}},
author = {{Gottlieb-Vedi, Eivind and Kauppila, Joonas H and Mattsson, Fredrik and Hedberg, Jakob and Johansson, Jan and Edholm, David and Lagergren, Pernilla and Nilsson, Magnus and Lagergren, Jesper}},
issn = {{1528-1140}},
language = {{eng}},
number = {{3}},
pages = {{429--436}},
publisher = {{Lippincott Williams & Wilkins}},
series = {{Annals of Surgery}},
title = {{Extent of Lymphadenectomy and Long-Term Survival in Esophageal Cancer}},
url = {{http://dx.doi.org/10.1097/SLA.0000000000005028}},
doi = {{10.1097/SLA.0000000000005028}},
volume = {{277}},
year = {{2023}},
}