• Waseem Lutfi, Deirdre Martinez-Meehan, Rajeev Dhupar, Neil Christie, Inderpal Sarkaria, Chigozirim Ekeke, Nicholas Baker, James D Luketich, and Olugbenga T Okusanya.
• University of Pittsburgh, School of Medicine, Pittsburgh, Pennsylvania.
• J Surg Oncol. 2020 Mar 1; 121 (4): 654-661.

Background And ObjectivesLymph node harvest during esophagectomy has been associated with improved survival for esophageal cancer but the value of enhanced lymph node harvest following complete pathologic response (pCR) is debated. This study investigated if increasing lymph node harvest in esophageal cancer patients with a pCR after neoadjuvant therapy and esophagectomy is associated with improved survival.MethodsWe queried the National Cancer Data Base for patients with esophageal cancer between 2004 and 2014 who underwent neoadjuvant chemotherapy or chemoradiation therapy followed by esophagectomy found to have pCR. Multivariable Cox modeling was utilized to evaluate the impact of increasing lymph node counts on overall survival (OS).ResultsA total of 1373 patients met inclusion criteria. A National Comprehensive Cancer Network compliant lymphadenectomy of ≥15 nodes was associated with improved survival (66.7% vs 51.1%; P < .001). Cox modeling showed that the first node cutoff to demonstrate a statistically significant improvement in OS was ≥7 nodes (hazard ratio [HR], 95% confidence interval [CI]: 0.81, 0.68-0.97; 5-year OS: 54.2%) with a trend of decreasing and statistically significant HRs until ≥25 nodes (HR, 95% CI: 0.52, 0.37-0.72; 5-year OS: 68.4%).ConclusionsHigh negative node counts after neoadjuvant therapy and esophagectomy are associated with improved survival in patients with pCR.© 2020 Wiley Periodicals, Inc.

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