Effectiveness of radical en-bloc-esophagectomy compared to transhiatal esophagectomy in squamous cell cancer of the esophagus is influenced by nodal micrometastases

• Published in: Journal of surgical oncology 2006-06, Vol.93 (7), p.541-549
• Main Authors: Yekebas, Emre F., Schurr, Paulus G., Kaifi, Jussuf T., Link, Bjoern C., Kutup, Asad, Mann, Oliver, Wolfram, Lars, Izbicki, Jakob R.
• Format: Article
• Language: English
• Subjects: Adult; Aged; Carcinoma, Squamous Cell - secondary; Carcinoma, Squamous Cell - surgery; en-bloc-esophagectomy; esophageal cancer; Esophageal Neoplasms - pathology; Esophageal Neoplasms - surgery; Esophagectomy - methods; Esophagectomy - mortality; Female; Humans; immunohistochemistry (IHC); Lymph Node Excision - statistics & numerical data; Lymph Nodes - pathology; Lymphatic Metastasis; Male; micrometastases; Middle Aged; minimal residual disease; squamous cell cancer (SCC); Survival Analysis; transhiatal esophagectomy; Treatment Outcome
• ISSN: 0022-4790; 1096-9098
• DOI: 10.1002/jso.20544

Purpose The appropriate surgery for curable squamous cell cancer (SCC) of the esophagus is discussed controversially. Patients and Methods Transthoracic esophagectomy (TTE) with radical en‐bloc‐lymphadenectomy was performed in 79/120 patients (66%). Due to severe comorbidity, 41/120 patients (34%) underwent less traumatizing transhiatal esophagectomy. Lymph nodes were stained using mAb BER‐Ep4. Results pN0 status was found in 54 patients (45%) and pN1 status in 66 patients (55%). In the pN0 subgroup, 30 out of 54 patients (55.6%) had occult tumor cells in lymph nodes detected with BER‐Ep4. pN1 patients had additional BER‐Ep4 positive cells in histopathologically negative lymph nodes in 41 out of 66 patients (59.2%). Median disease‐specific survival was 31.4 and 16.8 months for the transthoracic and transhiatal groups, respectively (P = 0.129). pN0 patients lived longer after transthoracic resection (P = 0.0349), and in the subgroup without lymph node micrometastases this effect was even stronger (P = 0.025). In contrast, in pN0 patients with nodal microinvolvement, TTE did not entail a survival benefit when compared with the transhiatal group (P = 0.333). Conclusion TTE results in improved outcome in the absence of lymph node micrometastases. Poor survival in patients with lymphatic micro‐dissemination indicates systemic disease and the need for adjuvant treatment. J. Surg. Oncol. 2006;93:541–549. © 2006 Wiley‐Liss, Inc.