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
OBJECTIVE:
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).
METHODS:
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.
RESULTS:
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.
CONCLUSIONS:
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.