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Nodal Metastasis From Locally Advanced Esophageal Cancer: How Neoadjuvant Therapy Modifies Their Frequency and Distribution

  • Gastrointestinal Oncology
  • Published:
Annals of Surgical Oncology Aims and scope Submit manuscript

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.

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ACKNOWLEDGMENT

The authors are extremely grateful to Linda Inverso for her kind help in the revision of the English language and for editing the final version of the paper.

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Authors and Affiliations

  1. Oncological Surgery Unit, Veneto Institute of Oncology (IOV-IRCCS), Padova, Italy

    Carlo Castoro MD, Marco Scarpa MD, Matteo Cagol MD, Francesco Cavallin MSc, Rita Alfieri MD & Ermanno Ancona MD

  2. Department of Surgical and Gastroenterological Sciences, University of Padova, Padova, Italy

    Alberto Ruol MD, Gianpietro Zanchettin MD & Ermanno Ancona MD

  3. Department of Pathology, University of Padova, Padova, Italy

    Massimo Rugge MD

Authors
  1. Carlo Castoro MD
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  2. Marco Scarpa MD
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  3. Matteo Cagol MD
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  4. Alberto Ruol MD
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  5. Francesco Cavallin MSc
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  6. Rita Alfieri MD
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  9. Ermanno Ancona MD
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Corresponding author

Correspondence to Carlo Castoro MD.

Additional information

Carlo Castoro and Marco Scarpa contributed equally to this study.

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Castoro, C., Scarpa, M., Cagol, M. et al. Nodal Metastasis From Locally Advanced Esophageal Cancer: How Neoadjuvant Therapy Modifies Their Frequency and Distribution. Ann Surg Oncol 18, 3743–3754 (2011). https://doi.org/10.1245/s10434-011-1753-9

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  • DOI: https://doi.org/10.1245/s10434-011-1753-9

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