676 NECESSITY OF EXTENDED LOWER PARATRACHEAL LYMPH NODE RESECTION DURING ESOPHAGECTOMY FOR CANCER

Objective To evaluate the impact of lower paratracheal lymph node resection on oncological radicality and complication rate during esophagectomy for cancer. Backround The ideal extend of lymphadenectomy (LAD) in esophageal surgery is debated. Until today, there has been no proof for improved survival after standardized paratracheal lymph node resection performing oncological esophagectomy. Methods Lymph nodes from the lower paratracheal station are not standardly resected during 2-field Ivor-Lewis esophagectomy for esophageal cancer. Retrospectively, we identified 200 patients operated in our center for esophageal cancer from January 2017—December 2019. Histopathologically, 143 patients suffered from adenocarcinoma, 53 patients from squamous cell carcinoma, two patients from neuroendocrine carcinoma, and one from melanoma of the esophagus. Patients with and without lower paratracheal LAD were compared to patients regarding demographic data, tumor characteristics, operative details, postoperative complications, tumor recurrence and overall survival. Results 103 of 200 patients received lower paratracheal lymph node resection. On average, six lymph nodes were resected in the paratracheal region with histopathological cancer positivity in two patients. Those two patients suffered from neuroendocrine carcinoma and melanoma, none of the AC or SCC patients were positive. There was no significant difference between both groups regarding age, gender, BMI, or comorbidity. Harvesting of lower paratracheal lymph nodes was associated with less postoperative overall complications (p-value 0,029). Regarding overall survival and recurrence rate no difference could be detected between both groups (p-value 0,168, respectively 0,371). Conclusion The resection of lower paratracheal lymph nodes during esophagectomy seems not mandatory for distal squamous cell carcinoma or adenocarcinoma of the esophagus. It may be necessary in NEC, Melanoma of the esophagus or on demand if suspicious LN are detected in the CT scan. No increase of morbidity was caused by paratracheal dissection.

Salvage thoracoscopic resection after nivolumab for stage IV

There are limited data on the surgical management of localized and residual diseases in patients with stage IV non-small-cell lung cancer that was treated with nivolumab. Herein, we present two patients who underwent salvage thoracoscopic resection for residual diseases (left lower lobectomy and paratracheal lymph node resection, respectively) after chemotherapy and immunotherapy for stage IV adenocarcinoma. The indications, intraoperative findings, and histopathological findings are discussed in this report.

Paratracheal lymph node metastasis in operable localized esophageal and gastroesophageal junction adenocarcinoma.

e15526 Background: Paratracheal lymph node (LN) is considered regional for esophageal cancer, but its metastatic rate and influence to survival remain unclear. We aimed to evaluate the frequency of paratracheal LN metastasis and its prognostic influence. Methods: 1199 patients with localized esophageal or gastroesophageal junction adenocarcinoma (EAC) (January 2002 and December 2016) in our Gastrointestinal Medical Oncology Database were analyzed. 1R, 1L, 2R, 2L, 4R, and 4L according to 8th AJCC classification were defined as paratracheal LN. Results: Of 1199 patients, 73 (6.1%) had positive parataracheal LN at diagnosis. The median overall survival (OS) in 73 patients with initial paratracheal LN involvement was 2.10 years (range, xx). Of 1071 patients who were eligible for recurrence evaluation, 70 patients (6.5%) developed positive paratracheal LN recurrences as first recurrence. The median time to recurrence was 1.28 years (range; 0.28-5.96 years) and the median OS after recurrence was 0.95 years (range; 0.03-7.89). OS in 35 patients who had only patatracheal LN recurrence was significantly longer than in patients who had with other distant recurrences (median 2.26 vs 0.51 years; p < 0.0001). Higher T stage (T3/T4) was an independently risk factor for paratracheal LN recurrence (OR 5.10, 95% CI 1.46-17.89). We segregated patients in 3 groups based on the distance from esophagogastric junction to tumor proximal edge (lower; ≤2cm, middle; 2.0-7.0cm, higher; > 7.0cm), positive paratrachal LN metastases were more frequent in the proximal tumors (lower 4.2%, middle 12.0%, higher 30.3%; Cochran-Armitage Trend test, p < 0.001). Conclusions: Paratracheal LN metastases were associated with shorter survival in localized EAC patients. Careful investigation and surveillance for paratracheal LN are warranted.