Positive peritruncal nodes for esophageal carcinoma - Not always a dismal prognosis

Background/Aims: For esophageal carcinoma, positive truncal nodes are consi dered distant metastases, and might be a contraindication for potentially c urative surgery. With the development of new diagnostic tools more/smaller peritruncal nodes may be found positive preoperatively. We evaluate whether it is justified to exclude all patients with positive peri-truncal nodes f rom curative surgery. Methods: Retrospective study of all patients undergoi ng transhiatal resection for a mid-distal esophageal carcinoma between 1993 and 1997. Results:110 patients underwent transhiatal resection for esophag eal carcinoma. Sixteen patients had tumor-positive, resectable peritruncal lymph nodes not identified preoperatively, changing preoperative stage ttl into postoperative stage IV (M1a). After follow-up of 2.9 years (0.07-7.6), 49 patients (45%) were alive. On multivariate analysis radicality and lymp h node status were independent prognostic factors. There was no significant difference in survival between stage III and stage IV (M1a) tumors: 1.7 an d 1.5 years, respectively (p = 0.87). At the end of follow-up, 4/16 patient s (25%) with stage IV (M1a) disease were alive without evidence of disease. Conclusion: The presence of malignant cells in smalt, resectable peritrunc al nodes does not preclude long-term survival. The results of new diagnosti c modalities should be interpreted cautiously, unlit firm criteria for irre sectability/incurability of positive truncal nodes are established. Copyrig ht (C) 2001 S. Karger AG, Basel.