TRANSHIATAL ESOPHAGECTOMY IS NOT ASSOCIATED WITH POOR QUALITY LYMPHADENECTOMY

ABSTRACT Background: Esophageal cancer neoadjuvant therapy followed by surgery increases the likelihood of treatment success. Aim: To evaluate variables that can influence the number of retrieved lymph nodes, the number of retrieved metastatic lymph nodes and lymphnodal recurrence in esophagectomy after neoadjuvant chemoradiotherapy. Methods: Patients of a single institute were evaluated after completion of trimodal therapy. Univariate and multivariate analyses were performed to evaluate variables that can influence in the number of retrieved lymph nodes and retrieved metastatic lymph nodes. Results: One hundred and forty-nine patients were included. Thoracoscopy access was considered an independent factor for the number of lymph nodes retrieved, but was neither related to the number of positive lymph nodes retrieved nor to lymphnodal recurrence. Pathological complete response on the primary tumor and male were independent variables associated with the number of positive lymph node retrieved. Pathological complete response on the primary tumor site did not statistically influence the likelihood of a lower number of lymph nodes retrieved. Conclusion: Patients submitted to esophagectomy after neoadjuvant chemoradiotherapy, thoracoscopic access is more accurate for pathological staging, even in a complete pathological response. With a proper patient selection, transhiatal surgery may preserve the quality of lymphadenectomy of the positive lymph nodes.

摘要
背景：食管癌新辅助治疗（neoadjuvant therapy）后联合手术可提升治疗成功的概率。
目的：评估可影响新辅助放化疗（neoadjuvant chemoradiotherapy）后食管切除术（esophagectomy）患者的清扫淋巴结（retrieved lymph nodes）数目、转移性清扫淋巴结（retrieved metastatic lymph nodes）数目以及淋巴结复发（lymphnodal recurrence）情况的相关变量。
方法：对单中心完成三联治疗（trimodal therapy）的患者资料进行回顾分析，采用单因素分析与多因素分析，评估对清扫淋巴结数目、转移性清扫淋巴结数目存在影响的相关变量。
结果：本研究共纳入149例患者。胸腔镜手术入路（thoracoscopy access）被认定为影响清扫淋巴结数目的独立影响因素，但与阳性清扫淋巴结数目及淋巴结复发均无相关性。原发肿瘤病理完全缓解（pathological complete response）以及男性性别为与阳性清扫淋巴结数目相关的独立变量。原发肿瘤部位的病理完全缓解并未对清扫淋巴结数目偏少的概率产生统计学意义上的显著影响。
结论：对于新辅助放化疗后接受食管切除术的患者，胸腔镜手术入路的病理分期准确性更高，即便患者存在原发肿瘤病理完全缓解的情况亦是如此。经合理的患者筛选后，经裂孔食管切除术（transhiatal surgery）可保障阳性淋巴结清扫的质量。