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J Thorac Cardiovasc Surg 2003;126:1121-1127
© 2003 The American Association for Thoracic Surgery

General thoracic surgery

Extracapsular lymph node involvement is a negative prognostic factor in T3 adenocarcinoma of the distal esophagus and gastroesophageal junction

^a Department of Thoracic Surgery, University of Leuven, Leuven, Belgium
^b Department of Pathology, University of Leuven, Leuven, Belgium
^c School of Public Health, Biostatistical Centre, University of Leuven, Leuven, Belgium

Read at the Eighty-second Annual Meeting of The American Association for Thoracic Surgery, Washington, DC, May 5-8, 2002.

Received for publication June 10, 2002; revisions received July 22, 2002; revisions received April 27, 2003; accepted for publication June 9, 2003.

^* Address for reprints: Dr T. Lerut, Catholic University Leuven, Department of Thoracic Surgery, UZ Gasthuisberg, Herestraat 49, Belgium
Toni.Lerut{at}uz.kuleuven.ac.be

OBJECTIVE: To assess prognosis according to whether lymph node involvement is intracapsular or with extracapsular breakthrough in adenocarcinoma of the distal esophagus and gastroesophageal junction.

MATERIALS AND METHODS: One hundred ninety-five consecutive patients with T3 adenocarcinoma of the distal esophagus and gastroesophageal junction between 1990 and 1999 were studied. All patients underwent primary R0 esophagectomy. The mean number of resected nodes per patient was 36.9. Survival was analyzed according to intracapsular and extracapsular involvement.

RESULTS: In N0 patients 5-year survival was 57% and 9-year survival was 38.7%. In patients with positive nodes these figures were 26.2% and 18.1%, respectively (P = .0069). Intracapsular and extracapsular node involvement showed 5- and 10-year survival of 40.9% and 21.7% versus 18% and 15.7%, respectively. There was no significant difference in 5- and 10-year survival between N0 and intracapsular node involvement (P = .43). However, there was a significant difference in survival between N0 and extracapsular node involvement (P = .002) and between intracapsular and extracapsular node involvement (P = .0001).

CONCLUSIONS: This study shows a significant difference in survival according to whether lymph node involvement was intracapsular or extracapsular. Patients with intracapsular lymph node involvement have similar survival rates as N0 patients. Extracapsular lymph node involvement is a bad prognostic factor, independent of the number of involved lymph nodes. The number of involved lymph nodes has an additive negative effect. These data may have an impact on treatment strategies.

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