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Esophagectomy with Extended Lymphadenectomy for Submucosal Esophageal Cancer: Long-Term Outcomes and Prognostic Factors

  • Thoracic Oncology
  • Published:
Annals of Surgical Oncology Aims and scope Submit manuscript

Abstract

Background

There are controversies regarding the extent of lymphadenectomy necessary during the course of esophagectomy for submucosal esophageal cancer. The purpose of this study was to examine the long-term outcomes after esophagectomy with extended lymphadenectomy in patients with submucosal esophageal cancer and to investigate the prognostic factors in these patients.

Materials

A prospectively maintained database identified 105 previously untreated patients with submucosal esophageal cancer who underwent transthoracic esophagectomy with three-field or two-field lymphadenectomy. Median follow-up was 101 months.

Results

All patients received R0 resection. Ninety-eight patients had squamous cell carcinoma, and seven had adenocarcinoma. Lymph node metastasis was present in 38 patients (36.2%), of whom 9 patients (23.7%) had positive cervical nodes. Thirty-five patients (33.3%) had other primary malignancies. The overall 5- and 10-year survival rates were 74.4 and 57.4%, respectively. The cause of death was recurrent disease in 16 patients, other malignancy in 12, and noncancer-related disease in 18. Univariate analyses demonstrated that other primary malignancy (P = 0.0041), poor differentiation (P = 0.0203), and angiolymphatic invasion (P = 0.0347) significantly affected overall survival. There was no difference in survival between patients with lymph node metastasis and those without (P = 0.9809). Multivariate analysis found other primary malignancy to be the only independent prognostic factor (hazards ratio, 2.295; 95% confidence interval, 1.201–4.386; P = 0.0119).

Conclusions

Esophagectomy with extended lymphadenectomy for submucosal esophageal cancer results in 57.4% survival at 10 years. Other primary malignancy is the only independent predictor affecting long-term survival. Patients should be examined rigorously for other primary malignancy as well as recurrent disease during long-term follow-up.

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Disclosure

All authors disclosed no financial relationships relevant to this publication.

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Authors and Affiliations

  1. Department of Surgery, Kurume University School of Medicine, Fukuoka, Japan

    Toshiaki Tanaka MD, Satoru Matono MD, Takeshi Nagano MD, Kazuo Shirouzu MD & Hiromasa Fujita MD

  2. Multidisciplinary Treatment Center, Kurume University Hospital, Fukuoka, Japan

    Hideaki Yamana MD

Authors
  1. Toshiaki Tanaka MD
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  2. Satoru Matono MD
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  3. Takeshi Nagano MD
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  4. Kazuo Shirouzu MD
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  5. Hiromasa Fujita MD
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  6. Hideaki Yamana MD
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Correspondence to Toshiaki Tanaka MD.

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Tanaka, T., Matono, S., Nagano, T. et al. Esophagectomy with Extended Lymphadenectomy for Submucosal Esophageal Cancer: Long-Term Outcomes and Prognostic Factors. Ann Surg Oncol 19, 750–756 (2012). https://doi.org/10.1245/s10434-011-2023-6

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  • DOI: https://doi.org/10.1245/s10434-011-2023-6

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