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Extent of Lymphaden...
Extent of Lymphadenectomy and Long-Term Survival in Esophageal Cancer
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- Gottlieb-Vedi, Eivind (author)
- Karolinska Institutet
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- Kauppila, Joonas H (author)
- Karolinska Institutet
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- Mattsson, Fredrik (author)
- Karolinska Institute,Upper Gastrointestinal Surgery, Department of Molecular medicine and Surgery, Karolinska Institutet, and Karolinska University Hospital, Stockholm, Sweden
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- Hedberg, Jakob, 1972- (author)
- Uppsala University,Uppsala universitet,Institutionen för kirurgiska vetenskaper,Department of Surgical Sciences, Uppsala University, Sweden
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- Johansson, Jan (author)
- Karolinska Institutet,Lund University,Lunds universitet,Upper Gastrointestinal Surgery,Forskargrupper vid Lunds universitet,Lund University Research Groups,Department of Surgery, Skåne University Hospital, Lund; Faculty of Medicine, Clinical Sciences, Lund University, Sweden
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- Edholm, David (author)
- Linköpings universitet,Linköping University,Avdelningen för kirurgi, ortopedi och onkologi,Medicinska fakulteten,Region Östergötland, Kirurgiska kliniken US
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- Lagergren, Pernilla (author)
- Karolinska Institutet
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- Nilsson, Magnus (author)
- Karolinska Institutet
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- Lagergren, Jesper (author)
- Upper Gastrointestinal Surgery, Department of Molecular medicine and Surgery, Karolinska Institutet, and Karolinska University Hospital, Stockholm, Sweden; School of Cancer and Pharmaceutical Sciences, King's College London, and Guy's and St Thomas’ NHS Foundation Trust, London, UK.
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(creator_code:org_t)
- Wolters Kluwer, 2023
- 2023
- English.
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In: Annals of Surgery. - : Wolters Kluwer. - 0003-4932 .- 1528-1140. ; 277:3, s. 429-436
- Related links:
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http://dx.doi.org/10...
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https://urn.kb.se/re...
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https://doi.org/10.1...
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https://lup.lub.lu.s...
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https://urn.kb.se/re...
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Abstract
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- Objective: To examine the hypothesis that survival in esophageal cancer increases with more removed lymph nodes during esophagectomy up to a plateau, after which it levels out or even decreases with further lymphadenectomy.Summary of Background Data: There is uncertainty regarding the ideal extent of lymphadenectomy during esophagectomy to optimize long-term survival in esophageal cancer.Methods: This population-based cohort study included almost every patient who underwent esophagectomy for esophageal cancer in Sweden or Finland in 2000-2016 with follow-up through 2019. Degree of lymphadenectomy, divided into deciles, was analyzed in relation to all-cause 5-year mortality. Multivariable Cox regression provided hazard ratios (HR) with 95% confidence intervals (95% CI) adjusted for all established prognostic factors.Results: Among 2,306 patients, the 2nd (4-8 nodes), 7th (21-24 nodes) and 8th decile (25-30 nodes) of lymphadenectomy showed the lowest all-cause 5-year mortality compared to the 1st decile (HR = 0.77, 95% CI 0.61-0.97, HR = 0.76, 95% CI 0.59-0.99, and HR = 0.73, 95% CI 0.57-0.93, respectively). In stratified analyses, the survival benefit was greatest in decile 7 for patients with pathological T-stage T3/T4 (HR = 0.56, 95% CI 0.40-0.78), although it was statistically improved in all deciles except decile 10. For patients without neoadjuvant chemotherapy, survival was greatest in decile 7 (HR = 0.60, 95% CI 0.41-0.86), although survival was also statistically significantly improved in deciles 2, 6, and 8.Conclusion: Survival in esophageal cancer was not improved by extensive lymphadenectomy, but resection of a moderate number (20-30) of nodes was prognostically beneficial for patients with advanced T-stages (T3/T4) and those not receiving neoadjuvant therapy.
Subject headings
- MEDICIN OCH HÄLSOVETENSKAP -- Klinisk medicin -- Cancer och onkologi (hsv//swe)
- MEDICAL AND HEALTH SCIENCES -- Clinical Medicine -- Cancer and Oncology (hsv//eng)
Keyword
- esophageal cancer
- esophagectomy
- lymph node
- lymphadenectomy
- surgery
- survival
Publication and Content Type
- ref (subject category)
- art (subject category)
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- By the author/editor
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Gottlieb-Vedi, E ...
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Kauppila, Joonas ...
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Mattsson, Fredri ...
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Hedberg, Jakob, ...
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Johansson, Jan
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Edholm, David
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Lagergren, Perni ...
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Nilsson, Magnus
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Lagergren, Jespe ...
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- About the subject
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- MEDICAL AND HEALTH SCIENCES
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MEDICAL AND HEAL ...
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and Clinical Medicin ...
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and Cancer and Oncol ...
- Articles in the publication
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Annals of Surger ...
- By the university
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Uppsala University
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Lund University
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Linköping University
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Karolinska Institutet