Perioperative morbidity and mortality after radical lymphadenectomy for operable esophageal cancer

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e15554 Background: The role of radical lymphadenectomy in localized resectable esophageal cancer is controversial. Radical lymphadenectomy confers more accurate staging, and improves locoregional control rates. However, there is no convincing evidence yet for a definite improvement in overall survival. Higher morbidity and mortality rates with radical lymphadenectomy are often quoted as reasons to avoid these procedures during esophageal resection. Methods: We retrieved data from October 2003 to December 2008 from a prospective surgical database maintained at a single tertiary cancer centre. Demographic data, operative details and postoperative morbidity and mortality were analysed. Postoperative complications analysed included need for prolonged ventilation, pulmonary complications, recurrent laryngeal nerve (RLN) paresis, cardiac ischemia and arrhythmias, and anastomotic leaks. Results: Six hundred and forty five patients (453 men, 192 women, mean age 53.6 years, range 19–76 years) were operated by transthoracic total esophagectomy for esophageal cancer between October 2003 and December 2007. Three hundred and ninety eight patients underwent two-field lymphadenectomy and 247 underwent three field radical lymphadenectomy. There was a higher incidence of prolonged ventilation (13.4% vs 6.6%, p=0.003), RLN paresis (61.4% vs 32.5%, p=0.000), and pulmonary complications (38.5% vs 24.4%, p=0.000) with radical three field lymphadenectomy compared to two field lymphadenectomy. The incidence of cardiac events (1.6% vs 2.6%, p=0.230), cardiac arrhythmias (5.8% vs 7.1%, p=0.640), anastomotic leaks (6.7% vs 8.2%, p=0.258) and postoperative mortality (5% vs 5.3%, p=0.80) were similar in the two groups. Conclusions: Radical three field lymphadenectomy increases pulmonary complication rates but has no impact on cardiac complications, anastomotic leaks, or operative mortality. No significant financial relationships to disclose.