Node status in transmural esophageal adenocarcinoma and outcome after en bloc esophagectomy

Objective: Adenocarcinoma has replaced squamous cell as the most common eso phageal cancer in the United States, The purpose of this study was to deter mine the prevalence and location of lymph node metastases, the feasibility of performing an R-0 resection, and disease recurrence and survival in pati ents with transmural adenocarcinoma of the lower esophagus and gastroesopha geal junction. Methods: Forty-four patients with transmural adenocarcinoma underwent en bloc esophagectomy with systematic thoracic and abdominal lymp hadenectomy. They were followed up for a median of 23 months. Results: Actu arial survival for the entire group was 26% at 5 years. The most important predictors of the likelihood of recurrent disease and 5-year survival were the presence and number of lymph node metastases and the ratio of involved to total removed nodes. Seven patients (16%) were found to have no lymph no de metastases and had an 85% 5-year survival. In contrast, patients with mo re than 4 involved nodes or a node ratio greater than 0.1 had a high likeli hood of recurrence and death. Location of involved lymph nodes did not pred ict the likelihood of recurrence or death. Despite all patients having tran smural tumors, recurrence within the field of the en bloc resection occurre d in only 1 patient (2%). Conclusions: En bloc esophagectomy in patients wi th transmural esophageal adenocarcinoma is required to obtain the survival benefit of an Ro resection, to adequately assess lymphatic tumor burden, an d to be able to predict the likelihood of recurrence and death and thereby guide the use of postoperative adjuvant therapy.