Prospective analysis of the diagnostic yield of extended en bloc resectionfor adenocarcinoma of the oesophagus or gastric cardia

Background: The extent of lymph node dissection can affect tumour node meta stasis staging. The resulting 'stage migration' might hamper stage-by-stage comparison between different forms of oesophageal resection. The aim of th is study was to assess the diagnostic impact of extended en bloc lymphadene ctomy in staging (adeno)carcinoma of the mid/distal oesophagus or gastric c ardia. Methods: This was a prospective study of 74 patients (67 men and seven wome n; median age 63 (range 40-78) years) who underwent extended oesophagectomy between 1994 and 2000. Results: A median of 31 (range 15-78) lymph nodes was resected (and identif ied), with a median of 5 (range 0-31) positive nodes. Twenty-seven patients (36 per cent) had tumour-positive nodes in extended fields: 15 patients (2 0 per cent) in the abdomen and 15 patients (20 per cent) in the mediastinum . Subcarinal nodes were most affected (19 per cent). Extended resection led to tumour upstaging in 17 patients (23 per cent); two patients had isolate d positive subcarinal nodes and 15 other tumours became M-1a owing to posit ive nodes near the coeliac axis, hepatic artery or splenic artery. Tumour p ositivity in paratracheal or aortopulmonary nodes occurred in 8 per cent of patients, without influencing staging. Conclusion: Extended en bloc lymphadenectomy altered staging in 17 of 74 pa tients (23 per cent) with adenocarcinoma of the oesophagus or cardia, mainl y into M-1a owing to positive coeliac nodes (20 per cent).