P-186OPTIMUM LYMPHADENECTOMY FOR ADENOCARCINOMA OF THE OESOPHAGUS: CUT-OFF NUMBER OF RESECTED NODES VERSUS TOTAL LYMPHADENECTOMY

• Published in: Interactive cardiovascular and thoracic surgery Vol. 17; no. suppl_1; pp. S48 - S49
• Main Authors: Perrone, Ottorino, Ruffato, A., Mattioli, S., Lugaresi, M., D'Errico, A., Malvi, D., Aprile, M.R., Raulli, G., Frassineti, L.
• Format: Journal Article
• Language: English
• Published: Oxford University Press 01-07-2013
• ISSN: 1569-9293; 1569-9285
• DOI: 10.1093/icvts/ivt288.186

Objectives
According to the Worldwide Oesophageal Cancer Collaboration (WECC), maximum 5-year survival is modulated by T classification: resecting a minimum of 10 nodes for pT1, 20 nodes for pT2, 30 nodes for pT3/4. To verify if the WECC parameters are applicable for adenocarcinoma of the oesophagus, we counted the number of lymph nodes resected/patient in a case series who received “total lymphadenectomy”.
Methods
We considered 194 consecutive patients. Visible nodes and fat tissue for each station (4L/R-3-4-7-10-8-9-15-16-17-18-19-20 TNM 7th ed. and pancreatic and pyloric nodes) were carefully resected, the number of nodes/station was counted by the pathologist. The bivariate correlation (Spearman's Rho [r]) between the mean number of harvested nodes and the corresponding pT parameter was calculated.
Results
Six thousand and ten lymph nodes were resected, with a median (IQR) of 30 per case (18-40). The median number of harvested nodes was 22.5 (11.7-37) for pT1, 31 (23.5-43.5) for pT2, 30 (16.5-38) for pT3 and 32 (17.5-45) for pT4a tumours. The number of nodes/patient ranged from 4 to 61. The number of nodes was: <10 in 21% (4/21) of pT1, <20 in 8% (2/27) of pT2, <30 in 44% (64/146) for pT3-4. No linear relationship between the mean number of nodes and T was calculated (rs = 0.040, P = 0.584).
Conclusions
For adenocarcinoma of the oesophagus, it is evident that in a high number of cases total lymphadenectomy is necessary to provide a number of nodes/T ratio close to the WECC indications which nevertheless are not applicable in all patients (in over 40% of T3/4) to estimate survival. In order to avoid the risk of undervaluing the quality of surgical resection because of the lack of resectable nodes, we suggest to adopt “total lymphadenectomy” rather than to refer to a theoretical nodes/T ratio.
Disclosure
All authors have declared no conflicts of interest.