The Impact of Paratracheal Lymphadenectomy on Lymph Node Yield and Short-Term Outcomes in Esophagectomy for Cancer: A Nation-Wide Propensity Score-Matched Analysis.

IF 1.8 3区医学 Q3 GASTROENTEROLOGY & HEPATOLOGY

Digestive Surgery Pub Date : 2023-01-01 DOI:10.1159/000530019

B Feike Kingma, Eliza R C Hagens, Mark I Van Berge Henegouwen, Alicia S Borggreve, Jelle P Ruurda, Suzanne S Gisbertz, Richard van Hillegersberg

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引用次数: 0

Abstract

Introduction: The balance between potential oncological merits and surgical risks is unclear for the additional step of performing paratracheal lymphadenectomy during esophagectomy for cancer. This study aimed to investigate the impact of paratracheal lymphadenectomy on lymph node yield and short-term outcomes in patients who underwent this procedure in the Netherlands.

Methods: Patients who underwent neoadjuvant chemoradiotherapy followed by transthoracic esophagectomy were included from the Dutch Upper Gastrointestinal Cancer Audit (DUCA). After propensity score matching Ivor Lewis and McKeown approaches separately, lymph node yield and short-term outcomes were compared between patients who underwent paratracheal lymphadenectomy versus patients who did not.

Results: Between 2011 and 2017, 2,128 patients were included. Some 770 patients (n = 385 vs. n = 385) and 516 patients (n = 258 vs. n = 258) were matched for the Ivor Lewis and McKeown approaches, respectively. Paratracheal lymphadenectomy was associated with a higher lymph node yield in Ivor Lewis (23 vs. 19 nodes, p < 0.001) and McKeown (21 vs. 19 nodes, p = 0.015) esophagectomy. There were no significant differences in complications or mortality. After Ivor Lewis esophagectomy, paratracheal lymphadenectomy was associated with longer length of stay (12 vs. 11 days, p < 0.048). After McKeown esophagectomy, paratracheal lymphadenectomy was associated with more re-interventions (30% vs. 18%, p = 0.002).

Conclusions: Paratracheal lymphadenectomy resulted in a higher lymph node yield but also in longer length of stay after Ivor Lewis and more re-interventions following McKeown esophagectomy.

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气管旁淋巴结切除术对食管癌患者食管切除术中淋巴结产量和短期预后的影响:一项全国性倾向评分匹配分析。

导言:对于食管癌患者在食管癌切除术期间进行气管旁淋巴结切除术的额外步骤，潜在的肿瘤学优点和手术风险之间的平衡尚不清楚。本研究旨在探讨荷兰气管旁淋巴结切除术对患者淋巴结产量和短期预后的影响。方法:接受新辅助放化疗后经胸食管切除术的患者来自荷兰上消化道癌症审计(DUCA)。在分别匹配Ivor Lewis和McKeown方法的倾向评分后，比较了行气管旁淋巴结切除术和未行气管旁淋巴结切除术的患者的淋巴结产量和短期结果。结果:2011年至2017年，纳入了2128例患者。分别有770例患者(n = 385 vs. n = 385)和516例患者(n = 258 vs. n = 258)与Ivor Lewis和McKeown方法匹配。Ivor Lewis的气管旁淋巴结切除术与更高的淋巴结产出率相关(23 vs 19个淋巴结，p <0.001)和McKeown (21 vs 19, p = 0.015)食管切除术。并发症和死亡率无显著差异。Ivor Lewis食管切除术后，气管旁淋巴结切除术与更长的住院时间相关(12天vs 11天，p <0.048)。McKeown食管切除术后，气管旁淋巴结切除术与更多的再干预相关(30%对18%，p = 0.002)。结论:气管旁淋巴结切除术导致更高的淋巴结产量，但Ivor Lewis术后住院时间更长，McKeown食管切除术后再次干预次数更多。

本文章由计算机程序翻译，如有差异，请以英文原文为准。

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来源期刊

Digestive Surgery 医学-外科

CiteScore

4.90

自引率

3.70%

发文量

审稿时长

3 months

期刊介绍： ''Digestive Surgery'' presents a comprehensive overview in the field of gastrointestinal surgery. Interdisciplinary in scope, the journal keeps the specialist aware of advances in all fields that contribute to improvements in the diagnosis and treatment of gastrointestinal disease. Particular emphasis is given to articles that evaluate not only recent clinical developments, especially clinical trials and technical innovations such as new endoscopic and laparoscopic procedures, but also relevant translational research. Each contribution is carefully aligned with the need of the digestive surgeon. Thus, the journal is an important component of the continuing medical education of surgeons who want their practice to benefit from a familiarity with new knowledge in all its dimensions.