Distribution of lymph node metastases in esophageal adenocarcinoma after neoadjuvant chemoradiation therapy: a prospective study

• Published in: Surgical endoscopy Vol. 34; no. 10; pp. 4347 - 4357
• Main Authors: Hagens, Eliza R. C., Künzli, Hannah T., van Rijswijk, Anne-Sophie, Meijer, Sybren L., Mijnals, R. Clinton D., Weusten, Bas L. A. M., Geijsen, E. Debby, van Laarhoven, Hanneke W. M., van Berge Henegouwen, Mark I., Gisbertz, Suzanne S.
• Format: Journal Article
• Language: English
• Published: New York Springer US 01.10.2020; Springer Nature B.V
• Subjects: Abdominal Surgery; Adenocarcinoma - pathology; Adenocarcinoma - therapy; Aged; Chemoradiotherapy - adverse effects; Chemotherapy; Esophageal cancer; Esophageal Neoplasms - pathology; Esophageal Neoplasms - therapy; Esophagus; Female; Gastroenterology; Gynecology; Hepatology; Humans; Lymph Node Excision; Lymph Nodes - pathology; Lymphatic Metastasis - pathology; Lymphatic system; Male; Medicine; Medicine & Public Health; Metastasis; Middle Aged; Neoadjuvant Therapy - adverse effects; Neoplasm Staging; Proctology; Prospective Studies; Radiation therapy; Risk Factors; Surgery; Survival Analysis; Time Factors; Lymphadenectomy; Neoadjuvant therapy; Lymph node metastases; Survival; Esophageal adenocarcinoma
• ISSN: 0930-2794; 1432-2218
• DOI: 10.1007/s00464-019-07205-y

Background The distribution of lymph node metastases in esophageal adenocarcinoma following neoadjuvant chemoradiation (nCRTx) is unclear, but may have consequences for radiotherapy and surgery. The aim of this study was to define the distribution of lymph node metastases and relation to the radiation field in patients following nCRTx and esophagectomy. Methods Between April 2014 and August 2015 esophageal adenocarcinoma patients undergoing transthoracic esophagectomy with 2-field lymphadenectomy following nCRTx were included in this prospective observational study. Lymph node stations according to AJCC 7 were separately investigated. The location of lymph node metastases in relation to the radiation field was determined. The primary endpoint was the distribution of lymph node metastases and relation to the radiation field, the secondary endpoints were high-risk stations and risk factors for lymph node metastases and relation to survival. Results Fifty consecutive patients were included. Lymph node metastases were found in 60% of patients and most frequently observed in paraesophageal (28%), left gastric artery (24%), and celiac trunk (18%) stations. Fifty-two percent had lymph node metastases within the radiation field. The incidence of lymph node metastases correlated significantly with ypT-stage ( p  = 0.002), cT-stage ( p  = 0.005), lymph angioinvasion ( p  = 0.004), and Mandard ( p  = 0.002). The number of lymph node metastases was associated with survival in univariable analysis (HR 1.12, 95% CI 1.068–1.173, p  < 0.001). Conclusions Esophageal adenocarcinoma frequently metastasizes to both the mediastinal and abdominal lymph node stations. In this study, more than half of the patients had lymph node metastases within the radiation field. nCRTx is therefore not a reason to minimize lymphadenectomy in patients with esophageal adenocarcinoma.