CLO21-027: Defining Optimal Lymph Node Dissection and Clinical Impact of Number of Harvested Lymph Nodes During Esophageal Resection for Early Stage Esophageal Cancer

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  • 1 H. Lee Moffitt Cancer Center & Research Institute, Tampa, FL
  • 2 Morsani College of Medicine, University of South Florida, Tampa, FL

Introduction: The optimal number of harvested lymph nodes (LNs) and its effect on clinical outcome remain controversial for patients with esophageal carcinoma. Objective of this study was to investigate the clinical impact of harvested LN with clinical outcome in patients with early esophageal cancer undergoing upfront esophagectomy. Materials and Methods: In this IRB-approved retrospective study of 1200 patients with esophageal cancer, we identified patients consecutively treated with upfront esophagectomy and had available lymphadenectomy data including LN count. The data were analyzed to determine if there was a relationship between LN count and outcome. Overall survival (OS) was estimated using Kaplan-Meier method, and impact of LN groups (dichotomized by median) were assessed using Cox proportional hazards regression and compared using log-rank test. Results: Between 1996-2019, 359 patients with esophageal cancer was treated with upfront esophagectomy. Median age was 65 years, and median follow-up duration was 63.7 months. Median number of harvested LN was 12 (inter-quartile range: 7-18). Median OS for the entire cohort was 99 months [95% confidence interval (95% CI) 73.9 – 124.1]. 5-year and 10-year actuarial OS was 59.2 and 45.2%, respectively. Patients dichotomized by median LN counts, patient with >12 nodes had significantly improved OS compared with ≤12 node group [median OS 124.4 (95%CI 86.1-162.2) vs 77.7 months (95% CI 44.7-110.7), respectively, p=0.033]. 10-year OS were 40.7% vs 51.2% for ≤12 and >12 LN groups, respectively. This statistical significance was lost when using ≤10 harvested nodes as dichotomization cut-off (p=0.2). Overall, 28/193 patients were upstaged from T0-T2/N0 to pathological stage IIb-IV after surgical resection. In multivariate analysis, nodal group remained significant (p=0.01) when compared with other established prognostic factors such as age at diagnosis (p=0.2), clinical (0.1), pathological stage (p=0.000). Conclusion: The minimum number of harvested lymph nodes in patients with esophageal cancer following upfront esophagectomy affects stage migration and translates into overall survival benefit. Based on this study we recommend minimum number of 13 nodes harvested during lymphadenectomy.

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Corresponding Author: Anupam Rishi, MD
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