Upper GI
Zachary E. Stiles, DO MS
Fellow
Roswell Park Comprehensive Cancer Institute
Lancaster, New York, United States
Disclosure: Disclosure information not submitted.
Reported rates of subcarinal lymph node (LN) metastases for esophageal carcinoma vary from 20-25% and the relevance of subcarinal LN dissection (LND) for gastroesophageal junction (GEJ) tumors is poorly defined. This study aimed to evaluate rates of subcarinal LN metastasis in GEJ carcinoma and determine its prognostic significance.
Methods: Patients with GEJ adenocarcinoma undergoing robotic minimally invasive esophagectomy (MIE) from 2018 – 2021 were retrospectively assessed within a prospectively maintained database. Baseline characteristics and outcomes were examined with attention to subcarinal LND and LN metastases.
Results:
Among 70 consecutive patients, the median age was 62, 85.7% were male, and most had Siewert type I or II tumors (50.0% and 48.6%, each). Most patients (78.6%) received neoadjuvant therapy: typically, carboplatin/paclitaxel with concomitant radiotherapy. Fifty-three patients (75.7%) underwent subcarinal LND. Groups (with/without subcarinal LND) were similar in terms of baseline characteristics. Morbidity rates were comparable, as were overall (OS) and disease-free survival (DFS). Three patients had subcarinal LN metastases (5.7%): all had Siewert type I tumors. Two had clinical evidence of LN metastases preoperatively and all three had non-subcarinal nodal disease. There was no difference between those with and without subcarinal LN metastases regarding tumor size, grade, lymphovascular invasion, or perineural invasion. Those with positive subcarinal LNs experienced reduced 1- and 3-year DFS compared to those without subcarinal metastases (67% and 0% vs 84% and 67%, p 0.017). 1- and 3-year OS were reduced as well for patients with subcarinal LN involvement, but this was not statistically significant (67% and 67% vs 98% and 79%, p 0.200).
Conclusions: In this consecutive series of patients with GEJ adenocarcinoma undergoing MIE, subcarinal LN metastases were found only in patients with type I tumors and were noted in just 5.7% of patients, which is lower than historical controls. DFS was reduced with subcarinal LN disease. This calls into question routine prophylactic subcarinal LND, especially for type 2 tumors.