Extent of lymph node removal during XXXX surgery and survival.

@entity1 @entity5 @entity418
BACKGROUND: It is unclear how the extent of surgical lymph node clearance influences prognosis after surgery for @entity418 . METHODS: This nationwide, population-based cohort study included 1044 @entity418 @entity1 who had undergone esophagectomy between 1987 and 2010 in Sweden, with follow-up until 2012. The independent role of lymph node removal in relation to survival was analyzed using Cox proportional hazards regression, providing hazard ratios (HRs) with 95% confidence intervals (CIs), adjusted for age, sex, comorbidity, @entity5 ( @entity5 ) stage, neo-adjuvant treatment, surgeon volume, and calendar period. Statistical tests were two-sided, except tests for trend. RESULTS: Analyzed as a linear variable, a higher number of lymph nodes removed did not influence the overall five-year mortality (adjusted HR = 1.00, 95% CI = 0.99 to 1.01). @entity1 in the third (7-15 nodes) and fourth (16-114 nodes) quartiles of removed nodes did not demonstrate any decreased overall five-year mortality compared with those in the lowest two quartiles (<7 nodes) (HR = 1.13, 95% CI = 0.95 to 1.35 and HR = 1.17, 95% CI = 0.94 to 1.46, respectively). In early @entity5 stages (Tis-T1) the hazard ratios indicated a worse survival with more lymphadenectomy using the median as cutoff (HR = 1.53, 95% CI = 1.13 to 2.06). Increased lymph node removal did not decrease mortality in any specific @entity5 stage. A greater number of metastatic nodes and a higher positive-to-negative node ratio were associated with strongly increased mortality. All results were similar when disease-specific mortality was analyzed. CONCLUSION: This population-based study indicates that more extensive lymph node clearance during surgery for @entity418 may not improve survival. These results challenge current clinical guidelines, and further research is needed to change clinical practice.
