The number of lymph nodes removed predicts survival in esophageal cancer: an international study on the impact of extent of surgical resection

Ann Surg. 2008 Oct;248(4):549-56. doi: 10.1097/SLA.0b013e318188c474.


Objective: Surveillance, Epidemiology and End Results (SEER) data indicate that number of lymph nodes removed impacts survival in gastric cancer. Our aim was to study this relationship in esophageal cancer.

Methods: The study population included 2303 esophageal cancer patients (1381 adenocarcinoma, 922 squamous) from 9 international centers that had R0 esophagectomy prior to 2002 and were followed at regular intervals for 5 years or until death. Patients treated with neoadjuvant or adjuvant therapy were excluded.

Results: Operations consisted of esophagectomy with (1700) and without (603) thoracotomy. Median number of nodes removed was 17 (IQR10-29). There were 508 patients with stage I, 853 stage II, and 942 stage III. Five-year survival was 40%. Cox regression analysis showed that the number of lymph nodes removed was an independent predictor of survival (P < 0.0001). The optimal threshold predicted by Cox regression for this survival benefit was removal of a minimum of 23 nodes. Other independent predictors of survival were the number of involved nodes, depth of invasion, presence of nodal metastasis, and cell type.

Conclusions: The number of lymph nodes removed is an independent predictor of survival after esophagectomy for cancer. To maximize this survival benefit a minimum of 23 regional lymph nodes must be removed.

Publication types

  • Comparative Study
  • Multicenter Study
  • Research Support, Non-U.S. Gov't

MeSH terms

  • Adenocarcinoma / mortality
  • Adenocarcinoma / secondary
  • Adenocarcinoma / surgery*
  • Aged
  • Asia / epidemiology
  • Carcinoma, Squamous Cell / mortality
  • Carcinoma, Squamous Cell / secondary
  • Carcinoma, Squamous Cell / surgery*
  • Confidence Intervals
  • Esophageal Neoplasms / mortality
  • Esophageal Neoplasms / pathology
  • Esophageal Neoplasms / surgery*
  • Esophagectomy / methods*
  • Europe / epidemiology
  • Female
  • Follow-Up Studies
  • Humans
  • Lymph Node Excision / statistics & numerical data*
  • Lymphatic Metastasis
  • Male
  • Middle Aged
  • Neoplasm Staging
  • North America / epidemiology
  • Prognosis
  • Proportional Hazards Models
  • Retrospective Studies
  • SEER Program
  • Survival Rate / trends
  • Time Factors