Impact of Dissected Lymph Node Count and Positive Lymph Node Ratio Following Esophagectomy on Long-Term Outcomes in Esophageal Cancer: A Systematic Review and Meta-Analysis
Objective:. This meta-analysis evaluated how the number of lymph nodes dissected (LND) and the positive lymph node ratio (LNR) following esophagectomy influence long-term outcomes in esophageal cancer. Background:. Esophagectomy is a critical treatment for esophageal cancer, but the optimal extent o...
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| Format: | Article |
| Language: | English |
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Wolters Kluwer Health
2025-06-01
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| Series: | Annals of Surgery Open |
| Online Access: | http://journals.lww.com/10.1097/AS9.0000000000000587 |
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| author | Eisuke Booka, MD, PhD, FACS Hiroya Takeuchi, MD, PhD, FACS Yuki Sakai, MD Ryoma Haneda, MD, PhD Wataru Soneda, MD, PhD Tomohiro Murakami, MD, PhD Tomohiro Matsumoto, MD, PhD Yoshifumi Morita, MD, PhD Hirotoshi Kikuchi, MD, PhD, FACS Yoshihiro Hiramatsu, MD, PhD Mark K. Ferguson, MD |
| author_facet | Eisuke Booka, MD, PhD, FACS Hiroya Takeuchi, MD, PhD, FACS Yuki Sakai, MD Ryoma Haneda, MD, PhD Wataru Soneda, MD, PhD Tomohiro Murakami, MD, PhD Tomohiro Matsumoto, MD, PhD Yoshifumi Morita, MD, PhD Hirotoshi Kikuchi, MD, PhD, FACS Yoshihiro Hiramatsu, MD, PhD Mark K. Ferguson, MD |
| author_sort | Eisuke Booka, MD, PhD, FACS |
| collection | DOAJ |
| description | Objective:. This meta-analysis evaluated how the number of lymph nodes dissected (LND) and the positive lymph node ratio (LNR) following esophagectomy influence long-term outcomes in esophageal cancer.
Background:. Esophagectomy is a critical treatment for esophageal cancer, but the optimal extent of lymphadenectomy remains debated, especially in the era of modern neoadjuvant protocols.
Methods:. A systematic electronic search of Embase, Medline, and the Cochrane Library was performed for studies published between 2000 and 2024. Included studies assess overall survival (OS) in patients with esophageal cancer undergoing esophagectomy with lymphadenectomy, comparing groups with high and low LND and LNR. A subset analysis examined outcomes in patients receiving neoadjuvant therapy.
Results:. In total, 18 and 19 articles were included in the LND and LNR meta-analyses, respectively. High LND and low LNR were associated with improved OS [LND: hazard ratio (HR) = 0.75, 95% confidence interval (CI) = 0.67–0.85, P < 0.01; LNR: HR = 0.39, 95% CI = 0.33–0.47, P < 0.001]. Subset analysis revealed that these survival benefits persisted in patients who received neoadjuvant therapy (LND: HR = 0.56, 95% CI = 0.34–0.93, P = 0.01; LNR: HR = 0.24, 95% CI = 0.15–0.39, P < 0.001).
Conclusions:. These findings highlight the prognostic importance of high LND and low LNR in improving OS following esophagectomy, regardless of neoadjuvant therapy. Extensive lymphadenectomy may enhance survival, and LNR provides a valuable prognostic tool for guiding postoperative treatment decisions. |
| format | Article |
| id | doaj-art-c66ec9f54b9c465bbaeed82ea93459ac |
| institution | DOAJ |
| issn | 2691-3593 |
| language | English |
| publishDate | 2025-06-01 |
| publisher | Wolters Kluwer Health |
| record_format | Article |
| series | Annals of Surgery Open |
| spelling | doaj-art-c66ec9f54b9c465bbaeed82ea93459ac2025-08-20T03:13:44ZengWolters Kluwer HealthAnnals of Surgery Open2691-35932025-06-0162e58710.1097/AS9.0000000000000587202506000-00023Impact of Dissected Lymph Node Count and Positive Lymph Node Ratio Following Esophagectomy on Long-Term Outcomes in Esophageal Cancer: A Systematic Review and Meta-AnalysisEisuke Booka, MD, PhD, FACS0Hiroya Takeuchi, MD, PhD, FACS1Yuki Sakai, MD2Ryoma Haneda, MD, PhD3Wataru Soneda, MD, PhD4Tomohiro Murakami, MD, PhD5Tomohiro Matsumoto, MD, PhD6Yoshifumi Morita, MD, PhD7Hirotoshi Kikuchi, MD, PhD, FACS8Yoshihiro Hiramatsu, MD, PhD9Mark K. Ferguson, MD10From the * Department of Surgery, Hamamatsu University School of Medicine, Shizuoka, JapanFrom the * Department of Surgery, Hamamatsu University School of Medicine, Shizuoka, JapanFrom the * Department of Surgery, Hamamatsu University School of Medicine, Shizuoka, JapanFrom the * Department of Surgery, Hamamatsu University School of Medicine, Shizuoka, JapanFrom the * Department of Surgery, Hamamatsu University School of Medicine, Shizuoka, JapanFrom the * Department of Surgery, Hamamatsu University School of Medicine, Shizuoka, JapanFrom the * Department of Surgery, Hamamatsu University School of Medicine, Shizuoka, JapanFrom the * Department of Surgery, Hamamatsu University School of Medicine, Shizuoka, JapanFrom the * Department of Surgery, Hamamatsu University School of Medicine, Shizuoka, JapanFrom the * Department of Surgery, Hamamatsu University School of Medicine, Shizuoka, Japan§ Department of Surgery, University of Chicago, Chicago, IL.Objective:. This meta-analysis evaluated how the number of lymph nodes dissected (LND) and the positive lymph node ratio (LNR) following esophagectomy influence long-term outcomes in esophageal cancer. Background:. Esophagectomy is a critical treatment for esophageal cancer, but the optimal extent of lymphadenectomy remains debated, especially in the era of modern neoadjuvant protocols. Methods:. A systematic electronic search of Embase, Medline, and the Cochrane Library was performed for studies published between 2000 and 2024. Included studies assess overall survival (OS) in patients with esophageal cancer undergoing esophagectomy with lymphadenectomy, comparing groups with high and low LND and LNR. A subset analysis examined outcomes in patients receiving neoadjuvant therapy. Results:. In total, 18 and 19 articles were included in the LND and LNR meta-analyses, respectively. High LND and low LNR were associated with improved OS [LND: hazard ratio (HR) = 0.75, 95% confidence interval (CI) = 0.67–0.85, P < 0.01; LNR: HR = 0.39, 95% CI = 0.33–0.47, P < 0.001]. Subset analysis revealed that these survival benefits persisted in patients who received neoadjuvant therapy (LND: HR = 0.56, 95% CI = 0.34–0.93, P = 0.01; LNR: HR = 0.24, 95% CI = 0.15–0.39, P < 0.001). Conclusions:. These findings highlight the prognostic importance of high LND and low LNR in improving OS following esophagectomy, regardless of neoadjuvant therapy. Extensive lymphadenectomy may enhance survival, and LNR provides a valuable prognostic tool for guiding postoperative treatment decisions.http://journals.lww.com/10.1097/AS9.0000000000000587 |
| spellingShingle | Eisuke Booka, MD, PhD, FACS Hiroya Takeuchi, MD, PhD, FACS Yuki Sakai, MD Ryoma Haneda, MD, PhD Wataru Soneda, MD, PhD Tomohiro Murakami, MD, PhD Tomohiro Matsumoto, MD, PhD Yoshifumi Morita, MD, PhD Hirotoshi Kikuchi, MD, PhD, FACS Yoshihiro Hiramatsu, MD, PhD Mark K. Ferguson, MD Impact of Dissected Lymph Node Count and Positive Lymph Node Ratio Following Esophagectomy on Long-Term Outcomes in Esophageal Cancer: A Systematic Review and Meta-Analysis Annals of Surgery Open |
| title | Impact of Dissected Lymph Node Count and Positive Lymph Node Ratio Following Esophagectomy on Long-Term Outcomes in Esophageal Cancer: A Systematic Review and Meta-Analysis |
| title_full | Impact of Dissected Lymph Node Count and Positive Lymph Node Ratio Following Esophagectomy on Long-Term Outcomes in Esophageal Cancer: A Systematic Review and Meta-Analysis |
| title_fullStr | Impact of Dissected Lymph Node Count and Positive Lymph Node Ratio Following Esophagectomy on Long-Term Outcomes in Esophageal Cancer: A Systematic Review and Meta-Analysis |
| title_full_unstemmed | Impact of Dissected Lymph Node Count and Positive Lymph Node Ratio Following Esophagectomy on Long-Term Outcomes in Esophageal Cancer: A Systematic Review and Meta-Analysis |
| title_short | Impact of Dissected Lymph Node Count and Positive Lymph Node Ratio Following Esophagectomy on Long-Term Outcomes in Esophageal Cancer: A Systematic Review and Meta-Analysis |
| title_sort | impact of dissected lymph node count and positive lymph node ratio following esophagectomy on long term outcomes in esophageal cancer a systematic review and meta analysis |
| url | http://journals.lww.com/10.1097/AS9.0000000000000587 |
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