The impact of extended lymphadenectomy on survival in esophageal adenocarcinoma with complete pathologic response: a retrospective study.

BACKGROUND: The impact of extended lymphadenectomy in esophageal adenocarcinoma (EAC) has been established in recent literature. The role of lymph node harvest in those achieving a complete pathologic response (CPR) is less clear. We aim to further investigate the impact of extended lymphadenectomy on survival in those patients with CPR. METHODS: The National Cancer Database (NCDB) was queried from 2006-2021 for patients with EAC without distant metastasis who received trimodal therapy. Groups of <10, 10-20, and >20 nodes harvested were established. Multivariable Cox regression and Kaplan-Meier survival analyses were conducted. RESULTS: Of 17,292 patients identified, 20.51% (n=3,547) had CPR. Multivariable analysis identified extended lymphadenectomy as an independent prognostic factor for survival in those with CPR [10-20 nodes, hazard ratio (HR) 0.847, P=0.03; >20 nodes, HR 0.768, P=0.01]. Median survival was longer in the 10-20 nodes (91.70 months) and >20 nodes (81.15 months) groups compared to the <10 nodes group (59.70 months, P=0.03), but similar between the 10-20 and >20 nodes groups (P=0.84). Analysis by clinical stage (cSTAGE) revealed no survival benefit with increasing nodal harvest in cSTAGE I (P=0.25) or cSTAGE II (P=0.12) disease. In those with cSTAGE III disease, increased nodal harvest served as an independent prognostic factor for survival (10-20 nodes HR 0.811, P=0.03; >20 nodes, HR 0.770, P=0.02). Median survival improved with 10-20 nodes (84.21 months) compared to <10 nodes (53.32 months, P=0.03) but not further with >20 nodes (74.64 months, P=0.74). CONCLUSIONS: These results suggest that the benefit of lymphadenectomy in those with CPR may be stage dependent. In our cohort, only those with cSTAGE III disease saw a benefit from a greater than >10 nodes harvest and no groups derived additional benefit from more extended lymphadenectomy (>20 nodes).

Duke Scholars

Author Britton Donato Surgery, Cardiovascular and Thoracic Surgery