부산대학교 도서관

Background Lymph node status in oesophageal carcinoma is an important prognostic factor and predictor of survival. However, specific metastatic distribution patterns, especially for superior mediastinal lymph nodes, are not defined; they may be dependent on tumour location, histology and use of neoadjuvant treatment. Consensus for an optimal surgical strategy with regards to superior mediastinal lymphadenectomy (SML) has therefore not been formed. We aim to assess the metastatic yield of superior mediastinal nodes in intra-thoracic oesophageal cancer while correlating results with preoperative PET-CT. Methods Data from 39 consecutive 2-stage and 3-stage fully Minimally Invasive Oesophagectomies (MIO) performed by a single surgical team for intra-thoracic oesophageal or gastro-oesophageal junction carcinoma (Siewert I/II) between September 2016 and December 2017 were analysed. In n = 7 (18%), SML was performed. Of these n = 1 was for mid-oesophageal adenocarcinoma (ACA) and n = 6 were for squamous cell carcinoma (SCC) (5 for mid-oesophageal and 1 for distal oesophageal, which had a 2-stage procedure). Histological superior mediastinal nodal analysis was correlated with pre-operative PET-CT. Results Median total lymph node count was 45 (IQR, 37–68), with median SML count of 8 (IQR, 5–22). Of 7 SML's, n = 1 (14.2%) revealed metastasis in 1/5 right paratracheal nodes. The patient had 3-stage MIO with no neo-adjuvant treatment for mid-oesophageal SCC. Final staging was pT3N2(6/45)M0. Preoperative PET-CT showed low avidity in right paratracheal nodes. Of the rest, 5 had negative PET-CT and 1 showed PET-positive paratracheal nodes, not confirmed histologically. The latter patient had neoadjuvant chemoradiotherapy for distal oesophageal ACA. Conclusion Although a small sample-sized study it demonstrates that PET-CT has a role in identifying metastatic superior mediastinal nodes. It can aid in the decision of resecting avid nodes but it should be born in mind that PET could have false positive results due to surrounding inflammation not uncommonly found in the lungs. False positivity (not confirmed histologically) may be also attributed to complete pathological lymph node response post neo-adjuvant treatment. SML's role is not as clear in distal oesophageal/GOJ cancer compared to mid-oesophageal, but PET-CT seems a useful adjunct. In the West, SML shows a low metastatic yield for intra-thoracic oesophageal cancer. Disclosure All authors have declared no conflicts of interest. [ABSTRACT FROM AUTHOR]