Ann Thorac Surg 2000;69:368
© 2000 The Society of Thoracic Surgeons
Discussions
Discussion
DR CHARLES L. WILLEKES (Muskegon, MI): That was an excellent paper. I enjoyed it very much. One question: did you notice any difference in the histological subtypes, squamous versus adenocarcinoma? And second of all, those patients who underwent complete resection, in regard to the number of nodes or the distance of the nodes from the primary tumor, were there any differences in outcome?
DR ALEXANDER: There were only three adenocarcinomas in this series, and the adenocarcinomas that were stage T4 were T4 because of aortic invasion. We have seen one adenocarcinoma with airway invasion. In terms of numbers of lymph nodes and distant lymph nodes, an exclusion criterion for this protocol was celiac lymph node disease. In terms of numbers of lymph nodes, we did not use lymph node mapping, which I think everyone should, so our data are incomplete on that.
I would tell you that my impression is that patients meeting the new N2 staging criterion for esophageal cancer do much worse, and, in general, lymphatic metastases appears to be a very powerful predictor of survival, as we showed, even in patients with huge primary tumors. I think it would be worse in patients with more extensive lymph adenopathy.
Related Article
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Aggressive multimodality therapy for stage III esophageal cancer: a phase I/II study
- E. Pendleton Alexander, Timothy Lipman, John Harmon, and Robert Wadleigh
Ann. Thorac. Surg. 2000 69: 363-368.
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