| HOME | HELP | FEEDBACK | SUBSCRIPTIONS | ARCHIVE | SEARCH | TABLE OF CONTENTS |
|
|
|
|||||||
|
|||||||||
Department of Cardiothoracic Surgery, Weill Medical College of Cornell University, 525 East 68th St, New York, NY 10021
(Email: nkaltork{at}med.cornell.edu; brs9035{at}med.cornell.edu).
Surgical resection remains the cornerstone of treatment of esophageal cancer. However, there is less certainty regarding the extent of lymph node dissection necessary at the time of surgery. Some hold that the disease is systemic at the time of diagnosis and that an extensive nodal dissection only adds to the morbidity of the operation without a meaningful improvement in survival. Others, including our group, have argued that extended nodal dissection improves staging, local disease control, and perhaps even survival. The authors of the current article provide further evidence that lymph node resection does matter.
Lin and colleagues [1] should be complimented for their attention to detail in the conduct of their operations and in the cataloguing of their data. They present a systematic review of 109 patients undergoing primary resection for squamous cell cancer of the esophagus. The authors meticulously documented the primary site of the tumors as well as the sites of lymph node metastases. Several points from the article merit recognition.
Their data show that esophageal cancer readily and frequently spreads to nonregional lymph nodes. Sixty-two percent of their patients with nodal metastases had pathologically confirmed involvement of the nonregional lymph nodes, which was stage IV by the current staging system. This emphasizes the importance of multi-level lymph node dissection. Furthermore, the 26-month median survival in this group of patients after surgery alone calls into question whether they should truly be considered as stage IV.
The second important point in the article is that the number of involved lymph nodes rather than the location is the important determinant of survival. Other groups have noted this as well, with minor differences in the cut-off values. It seems that the next iteration of the esophageal staging system should include a nodal designation based on the number of involved lymph nodes.
Finally, the concept put forth by the authors regarding the requirement for a minimal number of lymph nodes dissected should be emphasized. Unfortunately, this is not the pattern of practice in the United States. A recent analysis of the Surveillance, Epidemiology and End Results (SEER) data for esophageal cancer showed that the median number of total lymph nodes resected in over 5,600 esophagectomies was only eight [2]. Clearly, we have to do a better job in this regard, if for no other reason than to adequately stage these patients and subsequently better evaluate our treatment modalities. Secondary benefits such as reduced locoregional recurrence and enhanced survival may follow.
 |
References |
|---|
 Top References |
|---|
Related Article
| ||||||||||||||||||||||||||||||||||||||||||||||||||||||||||||||||||||||||||
| HOME | HELP | FEEDBACK | SUBSCRIPTIONS | ARCHIVE | SEARCH | TABLE OF CONTENTS |
| ANN THORAC SURG | ASIAN CARDIOVASC THORAC ANN | EUR J CARDIOTHORAC SURG |
| J THORAC CARDIOVASC SURG | ICVTS | ALL CTSNet JOURNALS |
