Objective: The rising incidence of esophageal adenocarcinoma represents a real increase in disease burden, associated with a poor prognosis at 5 year after surgery. Our aim was to study the potential benefit of lymphadenectomy in the surgical treatment for esophageal cancer.
Methods: The study population included all patients with cancer of the intrathoracic esophagus and of the gastro-esophageal junction who underwent R0 esophago-gastric resection between 1992 and 2007.
Results: 643 patients were included. Median number of nodes removed was 18 (IQR 14-25). There were 110 patients with stage I (17.1%), 199 stage II (31%), 210 stage III (32.6%) and 50 stage IV (7.8%). The overall 5-year survival rate was 27.7%. The lymph node involvement was a significant negative predictor of survival (41.5% for pN0 patients versus 12.7% for pN1 patients, p<0.05) and, among the latter group of patients, the involvement of the celiac nodes determined a worse prognosis (6.5% versus 15%, p<0.05). The optimal threshold predicted by ROC analysis for the survival benefit of a more extended lymphadenectomy was removal of a minimum of 17 nodes. At multivariate analysis, the independent predictors of survival were the presence of nodal metastasis, the number of involved nodes, and patient’s age.
Conclusions: The extension of the lymphadenectomy is a key point in the surgical treatment of esophageal cancer. To maximize this survival benefit, a minimum of 17 regional lymph nodes must be removed.
