Curative Resection for Esophageal Adenocarcinoma

Abstract

Long-term survival from adenocarcinoma of the esophagus can be achieved in more than half the patients who undergo en bloc resection. One third of patients with lymph node involvement survived 5 years. Local control is excellent after en bloc resection. The extent of disease associated with tumors confined to the mucosa and submucosa provides justification for more limited and less morbid resections.

Lymph node metastases and prognosis in oesophageal carcinoma – A systematic review

“…The first approach is based on studies that showed and 24 months (95% CI: 18-30 months) [84]. The second school advocates an optimum cut off point, above which prognosis significantly falls [11,15,17,22,71], of 4 lymph nodes (reported range: 3-7 involved lymph nodes) [13, 14, 41, 54, 57, 71, 79, 87, 94 95]. When comparing patients with greater than four involved lymph nodes to those with four or less involved lymph nodes, the risk of developing recurrent disease rises from 45% to 82% and the 5-year survival is significantly reduced [13,22,71,87,89].…”

“…Lymph node metastases occur rapidly and extensively involving both the regional and systemic lymph nodes via the thoracic duct [54,79]. Studies have shown that up to 35% of T1b tumours and 78-85% of T3 tumours have lymph node metastases [11,18].…”

“…Studies have demonstrated that distant lymph node metastases occur in up to 40% of patients, with T2 and T3 tumours having a prevalence of 31% and 40% positive distant lymph nodes, respectively [11,42,59]. Distant lymph node metastases to upper mediastinum lymph nodes occur almost exclusively in patients with extensive regional lymph node involvement [96,100].…”

“…The overall 5-year survival rate after surgical resection is between 70% and 92% for patients without nodal involvement, but only 18% to 47% for patients with lymph node metastasis [8,10]. It is an accurate predictor of disease-free survival and can be used to identify patients who may require adjuvant chemotherapy or chemoradiotherapy to treat systemic metastases developing after primary resection [10,11].…”

Hand-Sewn Versus Stapled Esophagogastric Anastomosis in the Neck: A Systematic Review and Meta-analysis of Randomized Controlled Trials

“…With the development of surgical techniques, many advances have been applied to the surgery of esophageal cancer in the past decade [7,8]. Although lower rate of mortality has always been reported [9][10][11], the postoperative complications are proven to be frequently common, which included anastomotic leakage and stricture. Among the factors leading to the higher mortality, anastomotic leakage plays an essential role, with the rate ranging from 0 to 41 % [12].…”