22. Early Esophageal Cancer: Pattern Of Lymphatic Spread and Prognostic Factors For Long Term Survival After Surgical Resection
Hubert J. Stein, MD, FACS*, Marcus Feith, MD*, Bjorn L.D.M. Brucher, MD*, Mario Sarbia, MD*, Joerg R. Siewert, MD, FACS
Technische Universität München, Munich, Germany
Despite a lack of data on lymph node metastases, endoscopic ablation is increasingly applied in early esophageal cancer. We assessed the pattern of lymphatic spread and prognostic factors in a large single center series of surgically resected early esophageal cancer (high grade dysplasia HGD, mucosal cancer pT1a and submucosal cancer pT1b).
Over a 15 year period 282 patients with early esophageal cancer had esophageal resection with two-field lymphadenectomy. There were 151 adenocarcinomas (Barrett carcinoma: pT1a/HGD n=69, pT1b n=82) and 131 squamous cell cancers (SCC: pT1a/HGD n=24, pT1b n=107). Specimen were systematically assessed for pattern of lymphatic spread. Prognostic factors were determined by multivariate analysis. Median follow up is 6.5 years.
The median number of removed lymph nodes was 28. None of the 69 patients with HGD/pT1a Barrett carcinoma had lymphatic spread, compared to 2/24 (8.3%) patients with HGD/pT1a SCC. Lymphatic spread was also significantly more common in patients with submucosal SCC as compared to submucosal Barrett cancer (32.7% vs. 15.6%, p<0.01). Skipping of regional lymph node stations was frequent in SCC (34%), but not in Barrett cancer (6%). On multivariate analysis histologic tumor type (p<0.001) and lymphatic spread (p<0.001) were the only independent factors for long term survival. Five-year survival rate was 84.5% for Barrett cancer vs. 59.1% for SCC, and 51.2% vs. 82.3% for patients with/without lymphatic spread.
Pattern of lymphatic spread and long term prognosis differ markedly between SCC and Barrett cancer. Limited surgical resection and individualized lymphadenectomy appears applicable in early Barrett cancer.