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Background: There has been considerable debate around the influence of neoadjuvant therapy on lymph node harvest and the prognostic value of this information following esophagectomy for esophageal adenocarcinoma. The purpose of this study was to evaluate the effects of neoadjuvant therapy in the number of lymph node harvested, lymph node ratio and survival after esophagectomy.
Methods:
A single center retrospective analysis of 169 patients who underwent esophagectomy for esophageal adenocarcinoma was performed. Patients were divided in two groups: one group underwent neoadjuvant treatment prior to surgery (NEO) and another group underwent surgery only. (SURG).
Results: One hundred and three patients (61%) underwent neoadjuvant therapy (NEO) prior to resection. The mean age was 66 years (39-89), and 83 (82%) were treated with 2 or 3 field esophagectomy. Sixty six patients were treated with surgery alone (SURG). The mean age was 70 years (39-89) in this group, and 28 (44%) were treated with 2 or 3 field esophagectomy (p<0.001). The median number of nodes harvested in the NEO group and SURG group was 14.0 and 11.5 respectively (p=0.11). Looking soley at those undergoing 2 or 3 field esophagectomy in NEO to SURG groups, the median number of lymph nodes harvested was 16 and 15.5 respectively. In the NEO group the median number of lymph nodes harvested was 14.5 for complete responders, 16 for incomplete responders, 12 for non-responders, and 13 in those who were pathologically upstaged (p=0.252). The in-hospital mortality was 5% in the NEO group and 3% in the SURG group (p=0.56). The median lymph node ratio was 0 for complete responders, 0 for incomplete responders, 0.055 for non-responders and 0.125 for upstaged patients (p<0.001). Survival was influenced by the number of positive lymph nodes harvested in both groups (p<0.001). Survival was significantly improved by neoadjuvant therapy in stage III patients and in patients with N1 disease (p<0.001 and p=0.03, respectively).
Conclusion: At esophagectomy, the total number of lymph nodes harvested was not significantly influenced by neoadjuvant treatment or by the pathologic response to treatment. The number of positive lymph nodes was similar in both groups, but the lymph nodes ratio are inversely related to the response to neoadjuvant therapy. The only negative prognostic marker identified was presence of nodal disease. Neoadjuvant therapy improved survival in this group.