D. Giugliano1, A. Berger1, M. J. Pucci1, E. Rosato1, C. Lamb1, H. Meidl1, F. Palazzo1 1Thomas Jefferson University,Philadelphia, PA, USA
Introduction: Induction chemoradiation therapy for the treatment of locally advanced esophageal cancer has been used with increasingly successful outcomes. Lymph node retrieval after induction therapy is known to be decreased for rectal cancer and breast cancer. The aim of this study was to compare the differences in total lymph nodes (TLN), positive lymph nodes (PLN), and the ratio between positive lymph nodes and total lymph nodes (LNR) in patients who underwent esophagectomy with or without induction therapy.
Methods: We queried our IRB-approved prospective esophageal surgery database to identify a total of 175 patients who underwent minimally-invasive (MIE) or open esophagectomy (OE) from 2008 to 2015 for esophageal cancer. TLN, PLN and LNR were reviewed and compared using Student’s t-test. Significance was established at p<0.05.
Results:There were 70 patients (40.0%) who underwent esophagectomy without induction therapy and 105 patients (60%) with induction chemoradiation therapy. The majority of patients (n=157, 89.7%) underwent MIE while 18 (10.3%) had OE. Most patients (n=155, 88.5%) were diagnosed with adenocarcinoma. Complete pathologic response was seen in 28.6% of patients (n=30) who underwent induction therapy. Median TLN retrieval was significantly less (p=0.027) in those patients who underwent induction therapy (range: 0-53, median=18 ) compared to no induction (range: 9-57, median=21). Average PLN was less in induction patients (range: 0-13, average=0.74) compared to those without (range: 0-12, average=0.96; p=0.262), though this was not statistically significant. There was no difference in average LNR between the two groups (0.05 vs. 0.04, p=0.31).
Conclusion: Lymph node retrieval was significantly less in patients who underwent induction chemoradiation therapy for esophageal cancer. Though not statistically significant, there was a trend towards a lower number of positive lymph nodes in patients who underwent induction chemoradiation therapy, while the lymph node ratio did not differ. Further research is needed to determine whether this finding affects overall survival.