176. NON-REGIONAL LYMPHADENOPATHY IN PATIENTS WITH ESOPHAGEAL CANCER TREATED WITH CURATIVE INTENT: A PROPENSITY MATCHED ANALYSIS OF PATHOLOGICAL AND SURVIVAL OUTCOMES

Abstract

Abstract Background The management of patients with esophageal cancer and concurrent retroperitoneal or supraclavicular lymphadenopathy is controversial. Whilst these patients could be considered non-resectable, the survival benefit of neoadjuvant treatment followed by en bloc resection is not well described. The aim of this study was to explore the perioperative, pathological and survival outcomes of patients with esophageal cancer who presented with oligometastatic non-regional lymphadenopathy treated with neoadjuvant therapy and subsequent en bloc transthoracic esophagogastrectomy. Methods Between 01/2010 and 12/2022, a single center retrospective review of a prospectively maintained comprehensive esophageal cancer surgical database was performed. All patients with esophageal and junctional cancer with clinical non-regional (supraclavicular and retroperitoneal) lymphadenopathy were identified (Tany, Nany, M+). Only patients treated with neoadjuvant chemotherapy/chemoradiotherapy (nCT/nCRT) and extended en bloc transthoracic esophagogastrectomy including resection of the non-regional lymph node basin were included. Patients with gastric cancer and solid organ metastases were excluded. Propensity score matching was used to create a control group of clinically M- patients from same database to compare survival outcomes. Results Of the 46/1235 patients with non-regional lymphadenopathy, 39 met the inclusion criteria. Most had adenocarcinoma (35/39,89.7%) with retroperitoneal and supraclavicular lymphadenopathy in 26/39 (66.7%) and 16/39 (41.0%). nCRT and nCT was used in 5 and 34 patients respectively. Twenty-four received taxane based regimens and 24/39 (61.5%) adjuvant therapy. A trend towards improved overall survival was noted when comparing the study and control groups (27.0 vs 17.0 months, p = 0.065). However, cM+(retroperitoneal) had similar survival to the control group with both being higher than cM+(supraclavicular) (27.0 vs 21.0 vs 13.0 months, p = 0.039). Non-regional nodal basin sterilization occurred in 20/36 (55.6%) and was not associated with improved survival. Conclusion Whilst non-regional lymph node disease in the setting of esophageal cancer can be treated with neoadjuvant therapy and curative en bloc extended transthoracic resection, it seems that in terms of survival patients with retroperitoneal disease benefit the most. In this group of patients, equivalent survival to those with non-metastatic disease is achievable. Further understanding into those who would benefit from such a regimen is urgently needed.