Bo Jan Noordman1, David van Klaveren2, Mark I van Berge Henegouwen3, Bas P L Wijnhoven1, Suzanne S Gisbertz3, Sjoerd M Lagarde1,3, Ate van der Gaast4, Maarten C C M Hulshof5, Katharina Biermann6, Ewout W Steyerberg2, J Jan B van Lanschot1. 1. Department of Surgery, Erasmus MC University Medical Center Rotterdam, Rotterdam, The Netherlands. 2. Department of Public Health, Erasmus MC University Medical Center Rotterdam, Rotterdam, The Netherlands. 3. Department of Surgery, Academic Medical Center, Amsterdam, The Netherlands. 4. Department of Medical Oncology, Erasmus MC University Medical Center Rotterdam, Rotterdam, The Netherlands. 5. Department of Radiation Oncology, Academic Medical Center, Amsterdam, The Netherlands. 6. Department of Pathology, Erasmus MC University Medical Center, Rotterdam, The Netherlands.
Abstract
OBJECTIVE: To compare overall survival in patients with esophageal adenocarcinoma who underwenttranshiatal esophagectomy (THE) with limited lymphadenectomy or transthoracic esophagectomy (TTE) with extended lymphadenectomy with or without neoadjuvant chemoradiotherapy (nCRT). BACKGROUND: The application of neoadjuvant therapy might change the association between the extent of lymphadenectomy and survival in patients with esophageal adenocarcinoma. This may influence the choice of surgical approach in patients treated with nCRT. METHODS:Patients with potentially curable subcarinal esophageal adenocarcinoma treated with surgery alone or nCRT followed by surgery in 7 centers were included. The effect of surgical approach on overall survival, differentiated by the addition or omission of nCRT, was analyzed using a multivariable Cox regression model that included well-known prognostic factors and factors that might have influenced the choice of surgical approach. RESULTS: In total, 701 patients were included, of whom 318 had TTE with extended lymphadenectomy and 383 had THE with limited lymphadenectomy. TTE had differential effects on survival (P for interaction = 0.02), with a more favorable prognostic effect in patients who were treated with surgery alone [hazard ratio (HR) = 0.77, 95% confidence interval (CI) 0.58-1.03]. This association was statistically significant in a subgroup of patients with 1 to 8 positive lymph nodes in the resection specimen (HR = 0.62, 95% CI 0.43-0.90). The favorable prognostic effect of TTE over THE was absent in the nCRT and surgery group (HR = 1.16, 95% CI 0.80-1.66) and in the subgroup of nCRT patients with 1 to 8 positive lymph nodes in the resection specimen (HR = 1.00, 95% CI 0.61-1.68). CONCLUSIONS: Compared to surgery alone, the addition of nCRT may reduce the need for TTE with extended lymphadenectomy to improve long-term survival in patients with esophageal adenocarcinoma.
RCT Entities:
OBJECTIVE: To compare overall survival in patients with esophageal adenocarcinoma who underwent transhiatal esophagectomy (THE) with limited lymphadenectomy or transthoracic esophagectomy (TTE) with extended lymphadenectomy with or without neoadjuvant chemoradiotherapy (nCRT). BACKGROUND: The application of neoadjuvant therapy might change the association between the extent of lymphadenectomy and survival in patients with esophageal adenocarcinoma. This may influence the choice of surgical approach in patients treated with nCRT. METHODS:Patients with potentially curable subcarinal esophageal adenocarcinoma treated with surgery alone or nCRT followed by surgery in 7 centers were included. The effect of surgical approach on overall survival, differentiated by the addition or omission of nCRT, was analyzed using a multivariable Cox regression model that included well-known prognostic factors and factors that might have influenced the choice of surgical approach. RESULTS: In total, 701 patients were included, of whom 318 had TTE with extended lymphadenectomy and 383 had THE with limited lymphadenectomy. TTE had differential effects on survival (P for interaction = 0.02), with a more favorable prognostic effect in patients who were treated with surgery alone [hazard ratio (HR) = 0.77, 95% confidence interval (CI) 0.58-1.03]. This association was statistically significant in a subgroup of patients with 1 to 8 positive lymph nodes in the resection specimen (HR = 0.62, 95% CI 0.43-0.90). The favorable prognostic effect of TTE over THE was absent in the nCRT and surgery group (HR = 1.16, 95% CI 0.80-1.66) and in the subgroup of nCRT patients with 1 to 8 positive lymph nodes in the resection specimen (HR = 1.00, 95% CI 0.61-1.68). CONCLUSIONS: Compared to surgery alone, the addition of nCRT may reduce the need for TTE with extended lymphadenectomy to improve long-term survival in patients with esophageal adenocarcinoma.
Authors: Alicia S Borggreve; Lucas Goense; Peter S N van Rossum; Sophie E Heethuis; Richard van Hillegersberg; Jan J W Lagendijk; Marnix G E H Lam; Astrid L H M W van Lier; Stella Mook; Jelle P Ruurda; Marco van Vulpen; Francine E M Voncken; Berthe M P Aleman; Annemarieke Bartels-Rutten; Jingfei Ma; Penny Fang; Benjamin C Musall; Steven H Lin; Gert J Meijer Journal: Int J Radiat Oncol Biol Phys Date: 2020-01-25 Impact factor: 7.038
Authors: Apostolos Kandilis; Carlos Bravo Iniguez; Hassan Khalil; Emanuele Mazzola; Michael T Jaklitsch; Scott J Swanson; Raphael Bueno; Jon O Wee Journal: JTCVS Open Date: 2020-12-13