Z Gastroenterol 2019; 57(09): e192
DOI: 10.1055/s-0039-1695120
Ösophagus und Magen
Malignome im Ösophagus/Magen: Operationstechniken und Ergebnisse: Donnerstag, 03. Oktober 2019, 15:25 – 16:45, Studio Terrasse 2.1 B
Georg Thieme Verlag KG Stuttgart · New York

Laparoscopic Lymph Node Sampling for Patients with High-Risk Early Esophagogastric Junction Cancer resected Endoscopically

A Duprée
1   Universitätsklinikum Hamburg Eppendorf, Zentrum für Operative Medizin; Klinik und Poliklinik für Allgemein-, Viszeral- und Thoraxchirurgie, Hamburg, Deutschland
,
H Ehlken
2   Universitätsklinikum Hamburg-Eppendorf (UKE), Klinik f. Interdisziplinäre Endoskopie, Hamburg, Deutschland
,
T Rösch
2   Universitätsklinikum Hamburg-Eppendorf (UKE), Klinik f. Interdisziplinäre Endoskopie, Hamburg, Deutschland
,
M Reeh
1   Universitätsklinikum Hamburg Eppendorf, Zentrum für Operative Medizin; Klinik und Poliklinik für Allgemein-, Viszeral- und Thoraxchirurgie, Hamburg, Deutschland
,
Y Werner
2   Universitätsklinikum Hamburg-Eppendorf (UKE), Klinik f. Interdisziplinäre Endoskopie, Hamburg, Deutschland
,
O Mann
1   Universitätsklinikum Hamburg Eppendorf, Zentrum für Operative Medizin; Klinik und Poliklinik für Allgemein-, Viszeral- und Thoraxchirurgie, Hamburg, Deutschland
,
J Izbicki
1   Universitätsklinikum Hamburg Eppendorf, Zentrum für Operative Medizin; Klinik und Poliklinik für Allgemein-, Viszeral- und Thoraxchirurgie, Hamburg, Deutschland
,
S Groth
2   Universitätsklinikum Hamburg-Eppendorf (UKE), Klinik f. Interdisziplinäre Endoskopie, Hamburg, Deutschland
› Author Affiliations
Further Information

Publication History

Publication Date:
13 August 2019 (online)

Also available ateRef
 

Background and aims:

Endoscopic resection techniques such as endoscopic mucosal resection (EMR) or submucosal dissection (ESD) have been shown to be curative for early GI cancers, especially those in the upper GI tract. No further measures have to be taken in so-called low-risk cancers due to the low risk of lymph node (LN) metastases. In tumors not completely fulfilling these low-risk criteria but which were completely (R0) resected by endoscopy, full oncologic resection (e.g. esophagectomy) is still advised, but its benefit-risk ratio especially in elderly patients is still unclear.

Methods:

We retrospectively reviewed all our cases with endoscopically resected T1 esophagogastric junction tumors which did not fulfill the low risk criteria but had been completely resected by endoscopy. Before laparoscopic lymph node sampling (LLNS), reendoscopy with biopsy and abdominothoracic CT was to be performed. Main outcome parameters were number of resected LN and the percentage of positive LN. Patients were either offered conventional oncologic surgery in case of positive LN or follow-up if negative.

Results:

21patients with (n = 21) distal esophageal cancer were included, resected by either EMR (n = 6) or ESD (n = 15). LLNS results could be divided into two periods, before (n = 8) and after (n = 13) introduction of an extended LN sampling protocol. The latter increased the LN number from a mean of 12 LN (range 5 – 19) to a mean of 17,5 (range 12 – 40). Of all patients 14% showed lymph node metastasis (3/21). 0 patient in group 1, and 3 in group 2. All of them underwent minimalinvasive thoracoabdominal esophagectomy with gastric pull-up as a completion surgery. One of them showed short time cancer relapse in the specimen. Of the nodal negative patients (n = 18), 2 patients (11%) showed tumor relapse in the follow-period requiring surgical completion.

Conclusions:

An extended technique of laparoscopic lymph node sampling appears to provide adequate LN numbers to possibly guide further management. Only long-term follow-up of larger patient number will allow conclusions about oncologic adequacy of this concept.