TRANSHIATAL ESOPHAGECTOMY (THE) LYMPH NODE DISSECTION 101
James Kurtz*, Rene Borscheid, Edward E. Cho, Houssam Osman, D Rohan Jeyarajah
Surgery, Methodist Richardson Medical Center, Richardson, TX
Introduction: The number of lymph nodes removed has been shown to be an independent predictor of survival after esophagectomy in the setting of esophageal cancer. The National Comprehensive Cancer Network (NCCN) guidelines recommend that 15 lymph nodes be obtained for adequate staging of patients who did not receive preoperative chemoradiation. The optimum number of lymph after preoperative chemoradiation is not known. Transhiatal esophagectomy has been criticized as a less effective oncologic approach due to what is thought to be an inadequate lymphadenectomy. The purpose of this study was to evaluate the lymphadenectomy in transhiatal esophagectomy.
Methods: This was a retrospective review of all transhiatal esophagectomies performed at one of two tertiary care hospitals from January, 2013 to October, 2018. The main outcome measures included number of lymph nodes reviewed in pathology report, tumor grade, presence or absence of neoadjuvant chemo or radiation, clinical T and N staging, pathologic T and N staging, and achievement of R0 resection.
Results: One hundred and three transhiatal esophagectomies were performed at our institution from January 2013 to October 2018. One hundred one patients had at least clinical stage one esophageal cancer. Sixty cases were robotic, 24 laparoscopic, and 17 open. Our overall median lymph node retrieval was 13. In the setting of no neoadjuvant chemoradiation we averaged 15 lymph nodes. After neoadjuvant therapy there was an average of 13 lymph nodes retrieved. Although not statistically significant we did observe a higher average number of lymph nodes retrieved by robotic (13.5) and laparoscopic (14) approach compared to open (12.4). Higher number of lymph nodes were obtained in clinical N1 (14) and N2 (14) versus N0 (12.5).
Conclusions: Transhiatal esophagectomy can obtain an adequate lymphadenectomy. Minimally invasive esophagectomy provides an excellent lymph node clearance.
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