J Thorac Dis. 2017 Jul;9:S713-S723. doi: 10.21037/jtd.2017.07.42.
The extent of lymphadenectomy in esophageal resection for cancer should be standardized.
Journal of thoracic disease
Eliza R C Hagens, Mark I van Berge Henegouwen, Miguel A Cuesta, Suzanne S Gisbertz
Affiliations
Affiliations
- Department of Surgery, Academic Medical Center, Amsterdam, The Netherlands.
- Department of Surgery, VU Medical Center, Amsterdam, The Netherlands.
PMID: 28815067
PMCID: PMC5538989 DOI: 10.21037/jtd.2017.07.42
Abstract
The incidence of esophageal cancer increases, with approximately 482,000 patients diagnosed with esophageal cancer each year. Despite the growing incidence of esophageal carcinoma, the extent of the lymphadenectomy is still under discussion. Lymph node status is an important prognostic parameter in esophageal cancer and an independent predictor of survival. Surgical strategy depends on the distribution pattern of nodal metastases but consensus on the extent of lymphadenectomy differs worldwide. For squamous cell cancer, Japanese surgeons have standardized the 2- or 3-field lymphadenectomy according to the location of the tumor. For adenocarcinoma, in the Western World accounting for 85% of all esophageal cancers, the type of lymphadenectomy to perform is not clear. Moreover, the use of neoadjuvant therapy may influence the mediastinal lymph nodes and the significance of the lymphadenectomy for survival. These aspects have challenged the traditional policy concerning lymphadenectomy, at least in the Western World. Furthermore, an extensive lymphadenectomy may improve survival but, on the other hand, may cause significant more morbidity. An overview of the literature on the extent of lymphadenectomy for esophageal cancer with respect to the supposed lymph node distribution patterns for squamous cell carcinoma and adenocarcinoma, the different lymph node classification systems, the commonly used surgical techniques and outcomes, and the proposal of observational cohort study to standardize the type of lymphadenectomy according to the type of tumor, location and use of neoadjuvant therapy will be provided.
Keywords: Esophageal cancer; esophagectomy; lymph node metastases; lymphadenectomy
Conflict of interest statement
Conflicts of Interest: The authors have no conflicts of interest to declare.
References
- JAMA Surg. 2016 Jan;151(1):32-9 - PubMed
- J Thorac Oncol. 2013 Mar;8(3):359-65 - PubMed
- Ann Surg. 2014 Nov;260(5):786-92; discussion 792-3 - PubMed
- Surg Oncol. 2014 Sep;23(3):140-6 - PubMed
- Ann Surg Oncol. 2015 Feb;22(2):597-603 - PubMed
- Cancer. 2008 Mar 15;112(6):1239-46 - PubMed
- Ann Surg. 2010 Jan;251(1):46-50 - PubMed
- World J Surg Oncol. 2012 Oct 04;10:210 - PubMed
- Chin J Cancer. 2012 Jun;31(6):281-6 - PubMed
- World J Surg Oncol. 2016 Apr 19;14 :117 - PubMed
- Ann Surg Oncol. 2011 Dec;18(13):3743-54 - PubMed
- Ann Thorac Surg. 2010 Nov;90(5):1662-7 - PubMed
- Eur J Cardiothorac Surg. 1999 Jun;15(6):769-73 - PubMed
- J Surg Oncol. 2012 May;105(6):548-52 - PubMed
- J Thorac Cardiovasc Surg. 2009 Sep;138(3):594-602; discussion 601-2 - PubMed
- Ann Surg. 2014 Dec;260(6):1016-22 - PubMed
- Hepatogastroenterology. 2012 May;59(115):930-3 - PubMed
- Dis Esophagus. 2011 Jan;24(1):33-8 - PubMed
- Surg Clin North Am. 2000 Dec;80(6):1799-809 - PubMed
- Ann Surg. 2008 Aug;248(2):221-6 - PubMed
- Ann Surg. 1994 Sep;220(3):364-72; discussion 372-3 - PubMed
- Ann Surg. 2016 Nov;264(5):847-853 - PubMed
- Histopathology. 2007 Dec;51(6):733-42 - PubMed
- Ann Oncol. 2017 Mar 1;28(3):519-527 - PubMed
- Ann Thorac Cardiovasc Surg. 2012;18(4):306-13 - PubMed
- Surg Today. 1994;24(5):410-4 - PubMed
- Surg Today. 2014 Apr;44(4):607-19 - PubMed
- Ann Surg Oncol. 2013 Nov;20(12):4016-21 - PubMed
- N Engl J Med. 2002 Nov 21;347(21):1662-9 - PubMed
- J Surg Oncol. 2009 Mar 15;99(4):189-93 - PubMed
- Cancer Epidemiol Biomarkers Prev. 2010 Aug;19(8):1893-907 - PubMed
- Gut. 2011 Nov;60(11):1449-72 - PubMed
- Eur J Cardiothorac Surg. 2009 Sep;36(3):480-6 - PubMed
- Ann Surg Oncol. 2009 Feb;16(2):454-62 - PubMed
- Best Pract Res Clin Gastroenterol. 2006;20(5):893-906 - PubMed
- Hepatogastroenterology. 1999 Mar-Apr;46(26):717-25 - PubMed
- J Clin Oncol. 2001 Apr 1;19(7):1970-5 - PubMed
- World J Gastrointest Surg. 2016 Jan 27;8(1):90-4 - PubMed
- World J Gastroenterol. 2014 Dec 21;20(47):18022-30 - PubMed
- N Engl J Med. 2012 May 31;366(22):2074-84 - PubMed
- Eur J Cardiothorac Surg. 1999 Sep;16 Suppl 1:S44-7 - PubMed
- Ann Surg. 2005 Oct;242(4):566-73; discussion 573-5 - PubMed
- Gastrointest Endosc. 2007 Jan;65(1):3-10 - PubMed
- Ann Surg. 2000 Aug;232(2):225-32 - PubMed
- World J Surg. 2014 Jan;38(1):106-13 - PubMed
- N Engl J Med. 2006 Jul 6;355(1):11-20 - PubMed
- Ann Surg. 2002 Aug;236(2):177-83 - PubMed
- Ann Surg Oncol. 2014 Sep;21(9):2857-63 - PubMed
- Ann Surg. 2008 Oct;248(4):549-56 - PubMed
- Ann Surg. 2000 Sep;232(3):353-61 - PubMed
Publication Types