10-year survival following oesophagectomy and 2-field lymphadenectomy : a retrospective cohort study

Background: Only 12.6% of patients with oesophageal cancer in the UK will survive over 10 years. While oesophagectomy remains the best option for resectable oesophageal cancers, there is debate about the extent of lymphadenectomy during surgery and its impact on short and long-term outcomes. We analyzed the outcomes, including 5- and 10-year survivals, for patients undergoing oesophagectomy and radical lymphadenectomy by a single surgeon. Methods: All patients who underwent oesophagectomy for any stage of oesophageal cancer in a single tertiary centre in the United Kingdom, with or without neoadjuvant chemotherapy, were identified from a prospectively maintained database from 2006-2017. We describe long term survival by number of lymph nodes resected and lymph node ratio (the ratio between the number of positive nodes and total nodes resected). Results: Median survival following oesophagectomy was 66.3 months (95% CI: 53-71) with a minimum follow-up of 5 years. Most patients had adenocarcinomas (85.9%) followed by squamous carcinomas (8.5%). For all histologies, overall 5-year survival was 54% and 10-year survival was 40%. For patients with adenocarcinoma, resecting ≥24 lymph nodes improved survival compared with <24 nodes (median 73 months and 59 months respectively, p<0.038). The number of lymph nodes resected was an independent predictor of survival (p<0.001). For patients with any histology, a lower lymph node ratio indicated better survival (p<0.01). Conclusions: This study demonstrates an improved long-term survival following oesophagectomy combined with lymphadenectomy of ≥24 nodes. We did not have any loss to follow-up with a long follow-up period, strengthening reported results.