Radical Transhiatal Esophagectomy with Two-Field Lymphadenectomy and Endodissection for Distal Esophageal Adenocarcinoma
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< 0.05). The overallrate of R0 resections was 87.2% (82.2% RTE, 87.1% THE). Overallsurvival was similar within the two study groups. Complete tumorremoval, T and N stages, and the lymph node ratio were identified asprognostic factors for long-term survival. Overall survival was betterafter RTE than after conventional THE in patients with involved lymphnodes. The mean number of resected lymph nodes per patient in the RTEgroup was 26.7. Positive lymph nodes were most common in theparacardial region and at the lesser curvature (72%/10.8% of allinvaded abdominal nodes). In the mediastinum positive nodes were mostcommon in the paraesophageal and paraaortal region (48%/27% of all mediastinal nodes). Patients with positive abdominal and mediastinallymph nodes had a poor long-term prognosis. Distal adenocarcinoma ofthe esophagus can be safely resected by RTE with two-fieldlymphadenectomy and endodissection. This technique allows radical |P`enbloc|P' resection of the tumor-bearing distal third of the esophagus, which includes the primary area of lymph node metastasis ofadenocarcinoma of the distal esophagus: the lower mediastinum andparacardial region. The analysis showed that RTE incurred fewer cardiaccomplications and a better overall survival in N1-positive patientswhen compared retrospectively to THE. Intraoperative mediastinoscopy allows controlled dissection of the upper mediastinum and biopsy of several mediastinal lymph nodes, with the advantage of providingadditional staging information.
KeywordsLymph Node Positive Lymph Node Mediastinal Lymph Node Lymph Node Ratio Esophageal Adenocarcinoma
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