• Alexander W Phillips, Sjoerd M Lagarde, Maziar Navidi, Babbet Disep, and S Michael Griffin.
• *Northern Oesophago-Gastric Unit, Royal Victoria Infirmary, Newcastle-upon-Tyne, UK †Department of Surgery, Erasmus MC, Rotterdam, The Netherlands ‡Department of Histopathology, Royal Victoria Infirmary, Newcastle-upon-Tyne, UK.
• Ann. Surg. 2017 Apr 1; 265 (4): 750-756.

ObjectiveThe aim of this study was to evaluate the influence of lymph node yield and the location of nodes on prognosis in patients with distal esophageal or gastroesophageal junction adenocarcinoma who have received neoadjuvant chemotherapy followed by transthoracic esophagectomy.BackgroundDebate continues regarding the extent of lymphadenectomy required when carrying out an esophagectomy. Lymph node yield has been used as a surrogate for extent of lymphadenectomy. Node location must, however, be reviewed to determine the true extent of lymphadenectomy.MethodsData from consecutive patients with potentially curable adenocarcinoma of the lower esophagus or gastroesophageal junction were reviewed. Patients were treated with neoadjuvant chemotherapy, transthoracic esophagectomy, and 2-field lymphadenectomy. Outcomes according to lymph node yield were determined. Projected prognosis of carrying out less radical lymphadenectomies was calculated according to 3 groups: group 1-exclusion of proximal thoracic nodes, group 2-a minimal abdominal lymphadenectomy, and group 3-a minimal abdominal and thoracic lymphadenectomy.ResultsThree hundred five patients were included. Median cancer-related survival was 37.7 months (confidence interval 29-46 mo). Absolute lymph node retrieval was not related to survival (P = 0.520). An estimated additional 4 (2-6) cancer-related deaths were projected if group 1 nodes were omitted, 2 (1-4) additional deaths if group 2 nodes were omitted, and 9 (6-12) extra deaths if group 3 nodes were omitted. A minimal lymphadenectomy (groups 1, 2, and 3) was projected to lead to a 23% reduction in survival in patients with N1 or N2.ConclusionsThe present study demonstrates high lymph node yields are possible after transthoracic esophagectomy with en bloc 2-field lymphadenectomy in patients post neoadjuvant chemotherapy. This allows excellent postoperative staging. Furthermore, the extent of lymphadenectomy must be correlated with node location, which may have important implications in patients who have a less extensive lymphadenectomy.

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