Stellenwert der Lymphadenektomie im Rahmen der Ösophagusresektion bei Ösophaguskarzinomen und Karzinomen des gastroösophagealen Übergangs

The Role of Lymphadenectomy in Esophagectomy for Esophageal Carcinomas and Carcinomas of the Gastroesophageal Junction

by Rojan Yagdiran
Doctoral thesis
Date of Examination:2025-11-26
Date of issue:2025-11-05
Advisor:Prof. Dr. Michael Ghadimi
Referee:Prof. Dr. Michael Ghadimi
Referee:Prof. Dr. Lutz Trojan
Persistent Address: http://dx.doi.org/10.53846/goediss-11617

 

 

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Abstract

English

Esophageal carcinoma, a malignant neoplasm of the upper gastrointestinal tract, is among the most aggressive cancers in terms of prognosis and mortality. While squamous cell carcinoma remains the most common histological subtype worldwide, an increasing incidence of adenocarcinoma has been observed in Western countries. Early lymphatic metastasis, bidirectional lymphatic drainage, and the influence of neoadjuvant therapy on lymphatic pathways represent major challenges when determining the appropriate extent of lymphadenectomy. Radical lymphadenectomy aims to remove potentially positive lymph nodes, allowing for more accurate histopathological staging and improved locoregional tumor control. However, the optimal extent of lymphadenectomy remains unclear. Therefore, this study aimed to assess the prognostic significance of the number of resected lymph nodes as a potential predictor of improved outcomes. The present work is a retrospective cohort study including all patients who underwent subtotal esophagectomy with lymphadenectomy at our institution between 2015 and 2022 due to a malignant esophageal disease. All patients were included regardless of their pretreatment status. The cohort was divided into three groups according to the number of resected lymph nodes (<20 nodes, 20–29 nodes, >29 nodes). Univariate and multivariate analyses were performed to assess the impact of lymphadenectomy on predefined endpoints, including complication rate, overall survival, and progression-free survival. Overall, no increase in postoperative morbidity was observed with more radical lymphadenectomy. The results suggest that the surgeon has the greatest influence on the complication rate. With respect to overall and progression-free survival, lymph node status and depth of tumor invasion were identified as independent prognostic factors. The increasing number of resected lymph nodes could not be clearly established as a prognostic factor but showed a trend toward improved overall survival. The removal of infracarinal lymph nodes had no positive impact on overall or progression-free survival. The findings of this study underscore good surgical practice and the generally favorable outcomes of surgical therapy for esophageal carcinoma. To adequately determine the appropriate extent of lymphadenectomy in this setting, further studies are required. In particular, future stratified analyses should consider the influence of neoadjuvant therapy, tumor (T) stage, and histological grading to reach a consensus on the optimal extent of lymphadenectomy.
Keywords: Esophageal carcinoma; esophagectomy; lymphadenectomy; gastroesophageal junction; lymph node dissection; neoadjuvant therapy; surgical outcomes; retrospective; overall survival; progression-free survival; prognostic factors; postoperative morbidity