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2006 Abstracts: Skip metastasis in oesophageal carcinoma: incidence and prognostic value
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Skip metastasis in oesophageal carcinoma: incidence and prognostic value
Stephanie J. Gros1, Dean Bogoevski1, Florian Onken1, Bjoern C. Link1, Michale Bubenheim2, Lars Wolfram1, Uta Reichelt3, Oliver Mann1, Philipp Busch1, Emre F. Yekebas1, Jakob R. Izbicki1; 1General, Visceral and Thoracic Surgery, University Clinic Hamburg-Eppendorf, Hamburg, Germany; 2Institute for Medical Biometry and Epidemiology, University Clinic Hamburg-Eppendorf, Hamburg, Germany; 3Institute of Pathology, University Clinic Hamburg-Eppendorf, Hamburg, Germany

Objective: Although studies on lymphatic spread of oesophageal carcinoma have been previously conducted, the impact of skip metastases on prognosis still remains to be defined. Background: Skip metastases which have been well described in non-small cell lung carcinoma are reported to be associated with a more favourable postoperative prognosis in this tumor entity. Methods: Between 1992 and 2004, 368 patients were operated on due to adenocarcinoma or squamous cell carcinoma (SCC) of the oesophagus. Lymph nodes were mapped and grouped according to their location. The influence of continuous or discontinuous (“skipping”) lymph node spread on overall survival in pN1 disease (n=150) was evaluated. Histological type and operative approach were included in the analysis. Results: Positive continuous lymph nodes were identified in 76.7% (n=115) of patients. Skip metastases were found in 23.3% (n=35). In SCC, 34.2% (n=25) of patients had discontinuous lymph node spreading, whereas the incidence of skipping in adenocarcinoma was 12.5% (n=10). Overall, significant differences regarding survival were not identified between continuous and discontinuous lymphatic spread in adenocarcinoma and SCC. Neither a significant influence of surgical approach (transhiatal vs. thoracoabdominal) was found. Further sub-analysis showed that skip metastases in early T stages (pT1 and pT2) were associated with significantly better survival compared to patients with non-skip metastases (p=0.0399). Conclusion: The results overall showed an unpredictable lymphatic metastatic spreading pattern that is inconsistent with the sentinel node concept. However, better survival was recorded in patients with skip metastases in early pT1/2 oesophageal carcinoma as compared to continuous lymph node spread.


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