The Relevance of Lymphadenectomy Extension to the Right Paratracheal Space in the Treatment of Esophagogastric Junction Adenocarcinoma: A Retrospective Bicentric Study

TL;DR

A study of 147 patients found that removing lymph nodes near the trachea during surgery for a type of stomach-esophagus cancer did not improve survival and caused complications.

Contribution

The study provides evidence that extending lymphadenectomy to the right paratracheal space may not be beneficial for most patients with esophagogastric junction adenocarcinoma.

Findings

No patients had cancer in the right paratracheal lymph nodes, regardless of tumor spread.

Extending surgery to include these nodes was linked to complications like weight loss and lung fluid.

Five-year survival rates were 44% overall and 29% disease-free.

Abstract

Esophagogastric junction adenocarcinoma is a type of cancer occurring where the esophagus meets the stomach. Surgeons often remove nearby lymph nodes during surgery to reduce the risk of cancer spreading, but the benefit of removing nodes in the upper chest, specifically on the right side of the trachea, is unclear. In our study of 147 patients, none of these lymph nodes contained cancer, regardless of how far the tumor had spread along the esophagus. Extending the surgery to include these nodes did not appear to improve survival but was associated with typical postoperative complications such as weight loss, fluid in the lungs, and infections. These findings suggest that removing the right paratracheal lymph node may not be necessary for most patients. Future studies could focus on more precise surgical strategies to reduce complications while ensuring effective cancer treatment.

The benefit of extensive lymphadenectomy including the right paratracheal station (RPTS) in the upper mediastinum for esophagogastric junction (EGJ) adenocarcinoma remains controversial. Upper mediastinal lymph node (LN) involvement has been associated with esophageal invasion length, representing a potential research area. This study aimed to assess the rate of RPTS LN involvement in EGJ adenocarcinoma and its correlation with esophageal invasion length, as well as potential impacts on survival and postoperative complications. Patients undergoing two- or three-field esophagectomy with lymphadenectomy extended to the RPTS between 2006 and 2023 were retrospectively included. Patient, tumor, operative, and postoperative data were collected. Among 321 esophagectomies, 147 met inclusion criteria. Median esophageal invasion length was 3 cm. No patients (0%) had LN metastasis in the RPTS, regardless of invasion length (>4 cm or ≤4 cm). Postoperative complications occurred in 41.5% of patients, most commonly weight loss > 10% (29.2%), pleural effusion (21.1%), and infectious pneumonitis (19.7%). Five-year overall and disease-free survival rates were 44% and 29%, respectively. Our findings suggest that extending lymphadenectomy to the right paratracheal space fails to detect lymph node invasion in patients with esophageal invasion greater than or less than 4 cm in patients with esophageal adenocarcinoma.

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