Should en bloc esophagectomy be the standard of care for esophageal carcinoma?
Academic Article
Overview
abstract
OBJECTIVE: To determine the impact of radical node dissection on the recurrence patterns and survival rates of patients with carcinoma of the esophagus. SUMMARY BACKGROUND DATA: The role of esophagectomy with radical lymphadenectomy in the treatment of esophageal cancer is controversial. Most centers favor a limited operation with no attempt at nodal clearance. However, disease recurrence and patient survival rates remain dismal with or without preoperative therapy. The authors postulate that a more radical node dissection would reduce local failure rates and enhance survival. METHODS: One hundred eleven patients with esophageal cancer underwent en bloc esophagectomy with radical lymph node dissection between 1988 and 1998. In 90% of patients the procedure was applied nonselectively and without any preoperative therapy. Patients were prospectively followed up for recurrence patterns and survival. RESULTS: The 5-year survival rate including noncancer deaths was 40%. The 5-year survival rates for patients with stage 1, 2A, 2B, 3, and 4 disease were 78%, 72%, 0%, 39%, and 27%, respectively. Forty percent of patients had node-negative disease (5-year survival rate, 75%), and 60% had nodal metastases (5-year survival rate, 26%). Recurrence occurred in 39% of patients and was local in only 8%. CONCLUSIONS: Radical esophagectomy results in superior overall and stage-specific 5-year survival rates. Extensive node dissection has a positive impact on survival rates, particularly in patients with nodal metastases.
