Transhiatal Esophagectomy Is Not Associated With Poor Quality Lymphadenectomy

Abstract

Background:Esophageal cancer neoadjuvant therapy followed by surgery increases the likelihood of treatment success. Aim:To evaluate variables that can influence the number of retrieved lymph nodes, the number of retrieved metastatic lymph nodes and lymphnodal recurrence in esophagectomy after neoadjuvant chemoradiotherapy. Methods:Patients of a single institute were evaluated after completion of trimodal therapy. Univariate and multivariate analyses were performed to evaluate variables that can influence in the number of retrieved lymph nodes and retrieved metastatic lymph nodes. Results:One hundred and forty-nine patients were included. Thoracoscopy access was considered an independent factor for the number of lymph nodes retrieved, but was neither related to the number of positive lymph nodes retrieved nor to lymphnodal recurrence. Pathological complete response on the primary tumor and male were independent variables associated with the number of positive lymph node retrieved. Pathological complete response on the primary tumor site did not statistically influence the likelihood of a lower number of lymph nodes retrieved. Conclusion:Patients submitted to esophagectomy after neoadjuvant chemoradiotherapy, thoracoscopic access is more accurate for pathological staging, even in a complete pathological response. With a proper patient selection, transhiatal surgery may preserve the quality of lymphadenectomy of the positive lymph nodes.

Transhiatal Esophagectomy in Squamous Cell Carcinoma of the Esophagus: What Are the Best Indications?

“…As expected and reported in the literature, lymph node involvement was associated with worse prognosis in our sample 3 , 19 , 20 , 32 . Multivariable analysis revealed a 2.2-fold increase in overall mortality with metastasis to local lymph nodes.…”

Neoadjuvant Chemoradiotherapy Followed by Transhital Esophagectomy in Locally Advanced Esophageal Squamous Cell Carcinoma: Impact of Pathological Complete Response

“…However, since then, with the finding that the neoadjuvant regimen with Paclitaxel + Carboplatin has shown to have a better pathological response rate, this has been the protocol used in the Service, meaning that in the future, the casuistic will be more expressive and may add a better survival rate disease-free and 5-year survival. In addition, transhiatal esophagectomy showed acceptable rates of postoperative complications and in accordance with the literature 17,25 , therefore, still indicated in selected cases.…”

“…All patients underwent pyloromyotomy, and jejunostomy for early postoperative enteral nutritional support 3,25 .…”

Prof. Phd. Henrique Walter Pinotti: 1929 - 2010. Founder of the Brazilian College of Digestive Surgery

“…In his memorial, the following stand out: 590 publications in national and international journals; 26 awards; 46 films or videos and countless lectures at national and international congresses and courses; 191 book chapters and seven books, among which stand out Tratado de Cirurgia do Aparelho Digestivo, Acesso ao Esôfago Torácico por Transsecção Mediana do Diafragma, and Filosofia da Cirurgia (Textbook of Surgery of the Digestive System, Access to the Thoracic Esophagus by Median Diaphragm Transection, and Philosophy of Surgery) 2,3,4,5,6,7,8,9 .…”