Extent of Lymphadenectomy and Prognosis After Esophageal Cancer Surgery

JAMA Surgery
Jesper LagergrenAndrew Davies

Abstract

The prognostic role of the extent of lymphadenectomy during surgery for esophageal cancer is uncertain and requires clarification. To clarify whether the number of removed lymph nodes influences mortality following surgery for esophageal cancer. Conducted from January 1, 2000, to January 31, 2014, this was a cohort study of patients who underwent esophagectomy for cancer in 2000-2012 at a high-volume hospital for esophageal cancer surgery, with follow-up until 2014. The main exposure was the number of resected lymph nodes. Secondary exposures were the number of metastatic lymph nodes and positive to negative lymph node ratio. The independent role of the extent of lymphadenectomy in relation to all-cause and disease-specific 5-year mortality was analyzed using Cox proportional hazard regression models, providing hazard ratios (HRs) with 95% CIs. The HRs were adjusted for age, pathological T category, tumor differentiation, margin status, calendar period of surgery, and response to preoperative chemotherapy. Among 606 included patients, 506 (83.5%) had adenocarcinoma of the esophagus, 323 (53%) died within 5 years of surgery, and 235 (39%) died of tumor recurrence. The extent of lymphadenectomy was not statistically significantly...Continue Reading

Citations

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