Positive peritruncal nodes for esophageal carcinoma. not always a dismal prognosis

For esophageal carcinoma, positive truncal nodes are considered distant metastases, and might be a contraindication for potentially curative surgery. With the development of new diagnostic tools more/smaller peritruncal nodes may be found positive preoperatively. We evaluate whether it is justified to exclude all patients with positive peri-truncal nodes from curative surgery.

Retrospective study of all patients undergoing transhiatal resection for a mid-/distal esophageal carcinoma between 1993 and 1997.

110 patients underwent transhiatal resection for esophageal carcinoma. Sixteen patients had tumor-positive, resectable peritruncal lymph nodes not identified preoperatively, changing preoperative stage III into postoperative stage IV (M1a). After follow-up of 2.9 years (0.07-7.6), 49 patients (45%) were alive. On multivariate analysis radicality and lymph node status were independent prognostic factors. There was no significant difference in survival between stage III and stage IV (M1a) tumors: 1.7 and 1.5 years, respectively (p = 0.87). At the end of follow-up, 4/16 patients (25%) with stage IV (M1a) disease were alive without evidence of disease.

The presence of malignant cells in small, resectable peritruncal nodes does not preclude long-term survival. The results of new diagnostic modalities should be interpreted cautiously, until firm criteria for irresectability/incurability of positive truncal nodes are established.