Does Lymph Node Dissection During Esophagectomy Impact the Long-Term Prognosis for Complete Responders After...

Area of Science:

• Oncology
• Surgical Oncology
• Gastrointestinal Oncology

Background:

• Neoadjuvant therapy followed by esophagectomy is standard for locally advanced esophageal cancer.
• The role of lymph node dissection (LND) adequacy in patients achieving a pathologic complete response (pCR) after neoadjuvant therapy is unclear.
• This meta-analysis evaluates the survival impact of adequate LND in complete responders.

Purpose of the Study:

• To determine if adequate lymph node dissection (LND) is associated with improved survival outcomes in patients with esophageal cancer who achieved a pathologic complete response (pCR) after neoadjuvant therapy.
• To investigate the relationship between the extent of LND and overall survival (OS) and disease-free survival (DFS).

Main Methods:

• A systematic literature search identified eight studies with 2578 patients with pCR.
• Meta-analysis was used to assess the association between LND adequacy and survival endpoints.
• Subgroup analyses were conducted based on LND thresholds, pathology, and geographic region.

Main Results:

• Adequate LND was significantly associated with improved overall survival (OS) (HR 0.70; 95% CI 0.58-0.84).
• No significant improvement in disease-free survival (DFS) was observed (HR 0.72; 95% CI 0.24-2.20).
• Extensive LND beyond 40 harvested lymph nodes did not confer additional OS benefits. Adequate LND showed benefits in Western and adenocarcinoma populations, but not in Eastern populations or squamous cell carcinoma.

Conclusions:

• Adequate lymphadenectomy may correlate with better OS in patients with pCR, particularly in those with adenocarcinoma.
• The extent of lymph node dissection should be individualized based on histology and patient population.
• Findings suggest a tailored approach to LND in esophageal cancer management.