138P - Incidence of supracarinal lymph node positivity in operated cases of total esophagectomy: Short term results from a tertiary cancer centre

Background

The extent of lymphadenectomy in esophageal carcinoma (EC) has been subject of debate since several decades. Published literature is lacking in concrete evidence of supracarinal pathological lymph node (LN) involvement in middle and lower third EC, and its impact on oncologic outcomes. We present short-term institutional data for the rate of pathological supracarinal LN positivity in operated cases of EC.

Methods

A prospective study was conducted with ethics approval from April 2017 to August 2018. Patients of mid or lower third EC who were candidates for surgery were included. A supracarinal dissection was carried out separately in all the patients in addition to the standard two-field lymphadanectomy. Harvested nodal stations were labeled individually according to the Japanese Esophageal Classification and sent for histopathological examination. Outcomes were recorded in the postoperative period as well as during follow-up.

Results

Of the 76 patients that underwent an esophagectomy, 73 were squamous cell carcinomas whereas only 3 were adenocarcinomas. 44 (57.9%) of patients were stage II, 22 (28.9%) were stage III, and 7 (9.2%) were stage IB. 44 (57.9%) patients had prior chemoradiation, 9 (11.8%) had neoadjuvant chemotherapy whereas 18 (23.6%) did not receive any therapy prior to surgery. 26 (34.2%) cases were found to have pathological mediastinal nodes, of which supracarinal pathological nodes were found in 20 (26.3%) patients. Pathological supracarinal nodes were found in 16/51 (31.37%) patients with tumors of the middle one-third, and in 4/25 (16%) patients with lower one-third tumors. Average supracarinal LN yield was 10.33 (range- 2-32) nodes. 5 (6.5%) patients had only supracarinal LN positive for malignancy. 5 (6.57%) patients had pulmonary complications, 4 (4.52%) had RLN injury/ permanent hoarseness, and 6 (7.8%) had an anastomotic leak. In-hospital mortality was 4(5.2%).

Conclusions

Extended two field with supracarinal lymphadenectomy is strongly recommended in cases of middle third EC, who have received neoadjuvant treatment, although it should be considered even for lower third or gastroesophageal junction tumors.

Clinical trial identification

Editorial acknowledgement

Legal entity responsible for the study

The authors.

Funding

Has not received any funding.

Disclosure

All authors have declared no conflicts of interest.