The role of lymphadenectomy in esophageal cancer.

ABSTRACT

OBJECTIVE: To address the role of lymphadenectomy in the treatment of esophageal cancer. BACKGROUND: The role of lymphadenectomy in esophageal cancer surgery is controversial, and there is a lack of uniformity as to what the term means. METHODS: The published data was reviewed to evaluate the evidence base for, and the terminology associated with, lymphadenectomy for esophageal cancer. RESULTS: Recommendations are given for a standardization of terminology for radical and nonradical lymphadenectomy procedures. Although there is no doubt that the presence of lymph node metastases worsens prognosis for a patient, there is a lack of high-level evidence to support lymphadenectomy. Logically, the best procedure, from a staging and perhaps theoretical oncologic point of view, is a 3-field lymphadenectomy but it is not clear which patients, if any, are most likely to benefit. CONCLUSIONS: Well-designed randomized controlled trials are required to test, in a scientific manner, which of these procedures we should be offering our patients.