Il ruolo della linfoadenectomia nella chirurgia del cancro dell’esofago

Ruol, Alberto and Rizzetto, Christian and Castoro, Carlo and Cagol, Matteo and Alfieri, Rita and Michieletto, S. and Tosolini, C. and Zanchettin, G. and Zaninotto, Giovanni and Ancona, Ermanno (2009) Il ruolo della linfoadenectomia nella chirurgia del cancro dell’esofago. Il giornale di chirurgia, 30 (5 Supp). pp. 125-127. ISSN 1971-145x

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Objective: The rising incidence of esophageal adenocarcinoma represents a real increase in disease burden, associated with a poor prognosis at 5 year after surgery. Our aim was to study the potential benefit of lymphadenectomy in the surgical treatment for esophageal cancer. Methods: The study population included all patients with cancer of the intrathoracic esophagus and of the gastro-esophageal junction who underwent R0 esophago-gastric resection between 1992 and 2007. Results: 643 patients were included. Median number of nodes removed was 18 (IQR 14-25). There were 110 patients with stage I (17.1%), 199 stage II (31%), 210 stage III (32.6%) and 50 stage IV (7.8%). The overall 5-year survival rate was 27.7%. The lymph node involvement was a significant negative predictor of survival (41.5% for pN0 patients versus 12.7% for pN1 patients, p<0.05) and, among the latter group of patients, the involvement of the celiac nodes determined a worse prognosis (6.5% versus 15%, p<0.05). The optimal threshold predicted by ROC analysis for the survival benefit of a more extended lymphadenectomy was removal of a minimum of 17 nodes. At multivariate analysis, the independent predictors of survival were the presence of nodal metastasis, the number of involved nodes, and patient’s age. Conclusions: The extension of the lymphadenectomy is a key point in the surgical treatment of esophageal cancer. To maximize this survival benefit, a minimum of 17 regional lymph nodes must be removed.

Item Type: Article
Uncontrolled Keywords: Esophagus, cancer, lymphadenectomy, prognosis
Subjects: 600 Tecnologia - Scienze applicate > 610 Medicina e salute (Classificare qui la tecnologia dei servizi medici) > 617 Rami vari della medicina; Chirurgia
Depositing User: Nadia Del Gobbo
Date Deposited: 11 Feb 2016 15:30
Last Modified: 11 Feb 2016 15:30

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