Outcome of Patients with Esophageal Carcinoma and Suspicious Celiac Lymph Nodes as Determined by Endoscopic Ultrasonography

Background and Study Aims: The management of patients with esophageal cancer with malignant celiac lymph nodes (CLNs) is controversial. In this study we evaluated the management and survival of patients with positive CLN findings on endoscopic ultrasonography (EUS) and compared the outcome in surgically treated patients with that of nonsurgically treated patients.
Patients and Methods: The EUS database of the Academic Medical Center was retrospectively searched for patients with esophageal carcinoma and EUS-positive CLN. Follow-up comprised the review of medical charts and contact with general practitioners.
Results: From 1993 through 2000, 78 patients with esophageal carcinoma and suspicious CLN were eligible for inclusion in this study. The median survival of patients with CLN size < 2 cm was 13.5 months vs. 7.0 months for patients with CLN size >2 cm (P = 0.01). In a multivariate model, CLN size was the only predictive factor for poor patient survival. Of the 78 study patients, 13 underwent a surgical resection and 65 received nonsurgical treatment. The surgical group was significantly younger and all patients in this group had CLN size < 2 cm. The median survival for the surgical group was 13.7 months vs. 13.5 months for the nonsurgical group with CLN size < 2 cm (P = 0.63).
Conclusions: In this retrospective study, CLN size was a significant predictor for poor survival. The surgically treated patients had a medium-term survival similar to that of nonsurgically treated patients with a CLN size < 2 cm. These findings underline the prognostic value of CLN size in patients with esophageal carcinoma.

References

• 1 Daly J M, Fry W A, Little A G. et al . Esophageal cancer: results of an American College of Surgeons Patient Care Evaluation Study.  J Am Coll Surg. 2000;  190 562-572; discussion 572 - 573
• 2 Menke-Pluymers M B, Schoute N W, Mulder A H. et al . Outcome of surgical treatment of adenocarcinoma in Barrett's oesophagus.  Gut. 1992;  33 1454-1458
• 3 Fockens P, Kisman K, Merkus M P. et al . The prognosis of esophageal carcinoma staged irresectable (T4) by endosonography.  J Am Coll Surg. 1998;  186 17-23
• 4 Chak A, Canto M, Gerdes H. et al . Prognosis of esophageal cancers preoperatively staged to be locally invasive (T4) by endoscopic ultrasound (EUS): a multicenter retrospective cohort study.  Gastrointest Endosc. 1995;  42 501-506
• 5 Sobin L H, Wittekind C. TNM classification of malignant tumors. 5th edn. New York; Wiley-Liss 1997
• 6 Hagen J A, DeMeester S R, Peters J H. et al . Curative resection for esophageal adenocarcinoma: analysis of 100 en bloc esophagectomies.  Ann Surg. 2001;  234 520-530; discussion 530 - 531
• 7 Christie N A, Rice T W, DeCamp M M. et al . M1a/M1b esophageal carcinoma: clinical relevance.  J Thorac Cardiovasc Surg. 1999;  118 900-907
• 8 Catalano M F, Alcocer E, Chak A. et al . Evaluation of metastatic celiac axis lymph nodes in patients with esophageal carcinoma: accuracy of EUS.  Gastrointest Endosc. 1999;  50 352-356
• 9 Bergman J J, Fockens P. Endoscopic ultrasonography in patients with gastro-esophageal cancer.  Eur J Ultrasound. 1999;  10 127-138
• 10 Hulscher J B, Buskens C J, Bergman J J. et al . Positive peritruncal nodes for esophageal carcinoma: not always a dismal prognosis.  Dig Surg. 2001;  18 98-101
• 11 Altorki N, Skinner D. Should en bloc esophagectomy be the standard of care for esophageal carcinoma?.  Ann Surg. 2001;  234 581-587
• 12 Akiyama H, Tsurumaru M, Udagawa H, Kajiyama Y. Radical lymph node dissection for cancer of the thoracic esophagus.  Ann Surg. 1994;  220 364-372; discussion 372 - 373
• 13 Hiele M, de Leyn P, Schurmans P. et al . Relation between endoscopic ultrasound findings and outcome of patients with tumors of the esophagus or esophagogastric junction.  Gastrointest Endosc. 1997;  45 381-386
• 14 Eloubeidi M A, Wallace M B, Hoffman B J. et al . Predictors of survival for esophageal cancer patients with and without celiac axis lymphadenopathy: impact of staging endosonography.  Ann Thorac Surg. 2001;  72 212-219; discussion 219 - 220
• 15 Vazquez-Sequeiros E, Wiersema M J, Clain J E. et al . Impact of lymph node staging on therapy of esophageal carcinoma.  Gastroenterology. 2003;  125 1626-1635
• 16 Medical Research Council Oesophageal Cancer Working Group . Surgical resection with or without preoperative chemotherapy in oesophageal cancer: a randomised controlled trial.  Lancet. 2002;  359 1727-1733