Nodal metastasis from locally advanced esophageal cancer: How neoadjuvant therapy modifies their frequency and distribution

Carlo Castoro, Marco Scarpa, Matteo Cagol, Alberto Ruol, Francesco Cavallin, Rita Alfieri, Gianpietro Zanchettin, Massimo Rugge, Ermanno Ancona

Research output: Contribution to journalArticlepeer-review

Abstract

Background: Neoadjuvant chemoradiotherapy (CT-RT) before esophagectomy seems to affect the number of nodal metastasis and to alter the distribution of those that remain. The aim of this study was to define how neoadjuvant chemoradiotherapy changes nodal metastasis patterns in locally advanced esophageal cancer. Methods: A total of 402 consecutive patients with cancer of the esophagus or esophagogastric junction (181 adenocarcinoma [AC] and 221 squamous cell carcinoma [SCC]) (evaluated at clinical stage T1N1, T2N1, T3N0, or T3N1 and pathological stage M0) presenting in our Department between 1992 and 2007 and who underwent complete resection (R0) were included in this retrospective study on a prospectively collected database. All dissected lymph nodes were retrieved and microscopically analyzed. Nodal metastasis patterns in patients who underwent chemotherapy (CT) or chemoradiotherapy (CT-RT) neoadjuvant therapy were compared with those in patients who underwent surgery alone. Results: Almost 30% of the adenocarcinoma patients and approximately 40% of the SCC patients showed effective tumor downstaging after neoadjuvant therapy. There were fewer paracardial node metastases (P = .002) in the AC patients who underwent CT-RT neoadjuvant therapy. There were, likewise, significantly fewer paraesophageal, paracardial, and subcarinal node metastases in the SCC patients in whom the perigastric nodes became the second-most frequent site of metastasis. Conclusion: Not only was frequency of lymph node metastases decreased after neoadjuvant therapy, but nodal localization and pattern were also significantly modified.

Original languageEnglish
Pages (from-to)3743-3754
Number of pages12
JournalAnnals of Surgical Oncology
Volume18
Issue number13
DOIs
Publication statusPublished - Dec 2011

ASJC Scopus subject areas

  • Surgery
  • Oncology

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