How many lymph nodes removed during esophagectomy?

Joel C

This question comes from some observations made in Niki’s en-bloc esophagectomy post. I would be curious to know how many nodes were removed during your/or loved one’s esophagectomy (any type). I ask this question because during my MIE I had 15 nodes removed. I remember asking my surgeon when I woke up how many nodes were removed and when I heard 15 I was surprised because the number I was seeing during my research was closer to 30. I can’t say this has anything to do with my recurrence in a clavicle node in my neck but it sure makes me wonder. It would be interesting to know if there is some correlation between the number of nodes removed and survival rates.

Thank you,
Joel

Donna70

had 19 one was cancerous
Hi Joel,
This is a good question you are posting, I just read the other post about en bloc esophagectomy and am wondering is that what I had, I thought I had Ivor Lewis but I did have 3 incisions, one in neck, right side of chest and my upper abdomen. It is confusing to me, just know it wasn't the MIE. So I had had a positive node before chemo and radiation, when they operated the tumor and that node were obliterated, but out of 19 nodes taken one was positive and of course removed, then I had post op chemo to clean up and make sure. So far I have had all clear scans since my operation in 12/2010. I have wondered why more weren't taken but have been blessed to get this far. I am so hoping your scan was a fluke and the biopsy will be clear. take care,
Donna70

Donna70

had 19 one was cancerous
Hi Joel,
This is a good question you are posting, I just read the other post about en bloc esophagectomy and am wondering is that what I had, I thought I had Ivor Lewis but I did have 3 incisions, one in neck, right side of chest and my upper abdomen. It is confusing to me, just know it wasn't the MIE. So I had had a positive node before chemo and radiation, when they operated the tumor and that node were obliterated, but out of 19 nodes taken one was positive and of course removed, then I had post op chemo to clean up and make sure. So far I have had all clear scans since my operation in 12/2010. I have wondered why more weren't taken but have been blessed to get this far. I am so hoping your scan was a fluke and the biopsy will be clear. take care,
Donna70

Donna70

Donna70 said:

had 19 one was cancerous
Hi Joel,
This is a good question you are posting, I just read the other post about en bloc esophagectomy and am wondering is that what I had, I thought I had Ivor Lewis but I did have 3 incisions, one in neck, right side of chest and my upper abdomen. It is confusing to me, just know it wasn't the MIE. So I had had a positive node before chemo and radiation, when they operated the tumor and that node were obliterated, but out of 19 nodes taken one was positive and of course removed, then I had post op chemo to clean up and make sure. So far I have had all clear scans since my operation in 12/2010. I have wondered why more weren't taken but have been blessed to get this far. I am so hoping your scan was a fluke and the biopsy will be clear. take care,
Donna70

sorry about repeat don't know why it did that
sorry!!

skyhawk

I had 35 or so taken out at
I had 35 or so taken out at MD Anderson August 08. I was T3N1M0 and no problems as of yet. I know that MIE is the thing now, but I had the IL. I was just out there for my annual and we discussed MIE. While they are doing the "band-aid" type cuts on the abdomen, they are still using the incision on the back.

Several of the surgeons do the MIE, but they have gone back to the big incision on the back, because he point blank told me that they want to physically see the new junction, because they had a few leaks with the MIE, but not many, so the staff came to conclusion of this.

He said they also can take out many of the para tracheal nodes which they did on me with the big incision on the back. However, I would have liked the small incision on the gut, but I have done fine with no problems, so I can't complain.

preacherchad

I had 40 removed, 3 came
I had 40 removed, 3 came back positive.

Bobs1wife

MIE and 27 nodes removed-Great question you had!
My husband had robotic MIE at Mayo Clinic, Rochester. 27 nodes were removed. We knew of one positive node and it was close to the tumor. It was evidently completely destroyed with chemo/radiation. All looked good at surgery, but the pathology did show one node with scattered cells and it was one that didn't show up on any scans. It was in the gastric area. So, follow up chemo. One year since surgery CT scan was NED. Original dx was T3N1M0. Dx at surgery was T2N1M0. Linda

mruble

11 nodes removed
Joel --

My husband had 11 nodes removed during THE and all were cancerous. He was diagnosed with mets to the thyroid and nodes in the neck 10 months after surgery. I, too, wonder if things would have been different if more nodes had been removed.

Mary

birdiequeen

5 lymph nodes removed
My husband had 5 lymph nodes removed during his THE. I've wonder the same correlation question. Would also like to know if there is any health advantage/disadvantage to keeping your lymph nodes.

Bobs1wife

Another Question
Reading the replies made me think........If they took every node in the esophagus/gastric area, how many would that be?

NikiMo

preacherchad said:

I had 40 removed, 3 came
I had 40 removed, 3 came back positive.

What type of surgery?
Chad,

Do you mind sharing what type of surgery you had? Was it MIE or one of the others?

Thanks,

Niki

Unknown

skyhawk said:

I had 35 or so taken out at
I had 35 or so taken out at MD Anderson August 08. I was T3N1M0 and no problems as of yet. I know that MIE is the thing now, but I had the IL. I was just out there for my annual and we discussed MIE. While they are doing the "band-aid" type cuts on the abdomen, they are still using the incision on the back.

Several of the surgeons do the MIE, but they have gone back to the big incision on the back, because he point blank told me that they want to physically see the new junction, because they had a few leaks with the MIE, but not many, so the staff came to conclusion of this.

He said they also can take out many of the para tracheal nodes which they did on me with the big incision on the back. However, I would have liked the small incision on the gut, but I have done fine with no problems, so I can't complain.

This comment has been removed by the Moderator

JimboC

I had the MIE at Pittsburgh
I had the MIE at Pittsburgh on July 1st with Dr. Luketich and they removed 31 nodes. 3 came back positive so I am doing post-op chemo. I expect to return to work sometime in November.

GerryS

Nodes removed.........
My wife said they removed 7 nodes and one closest was infected. Had 3 months follow up chemo following surgery in March '10. NED for 18 months now. God Bless....

Gerry

preacherchad

NikiMo said:

What type of surgery?
Chad,

Do you mind sharing what type of surgery you had? Was it MIE or one of the others?

Thanks,

Niki

Ivor Lewis
Niki

Hi, I had the Ivor Lewis. I am not saying it is better or worse than other forms of surgery for EC. There are pros and cons on both sides. If I had to do over again, after knowing what I know now, I would still have the Ivor Lewis.

MIE is a minimually invasive surgery where 8 small incisions are made. The longest is 2 to 3 inches in length. Ivor Lewis has two large incisions, one on the abdoman and one on the back. The one on the front for me was 7 inches and the one on the back, that follows the shoulder blade around under the arm about 14 inches. (No, you are not a beach beauty after this surgery). I feel very comfortable with the Ivor Lewis and the scars are becoming less noticable each day.

Feel free to ask me any question regarding my experience.

jthomas233

unknown said:

This comment has been removed by the Moderator

"Minimally Invasive Ivor Lewis"
I'm actually having a "minimally invasive Ivor Lewis", which is much like what Lukitech does, only they make the larger cut in the right chest area. That's where they do the anastomosis.

There are puts and takes to both, and the description of the surgery I am having can be found here.

http://ats.ctsnetjournals.org/cgi/content/full/72/2/593

Here is a small excerpt-

Ivor Lewis esophagectomy consists of a laparotomy and right thoracotomy for resection of the esophagus with an intrathoracic esophagogastric reconstruction [2]. Advantages of this technique are the ability to perform a complete mediastinal lymphadenectomy and a good exposure of the mediastinal esophagus to obtain surgical hemostasis. In addition, a wide resection of the gastric cardia is possible, because the anastomosis is performed in the right chest. Disadvantages of the Ivor Lewis approach are the need for single lung ventilation, morbidity associated with a thoracotomy, and the potential for a life-threatening condition if a postoperative anastomotic leak occurs.

Our minimally invasive Ivor Lewis esophagectomy is similar to the operation originally described by Lewis [2] but, instead of a laparotomy and a right thoracotomy incision, we used laparoscopy and thoracoscopy. In the first stage, we commenced with laparoscopy and mobilization of the gastric conduit. The second stage consisted of thoracoscopic mobilization of the esophagus, removal of the esophagogastric specimen, and creation of an intrathoracic anastomosis. Important technical points to emphasize are (1) divide the stomach 2 cm to 3 cm below the gastroesophageal mass to ensure a negative margin of resection, (2) perform a Kocher maneuver to gain length of the gastric conduit, and (3) remove the surgical specimen using a specimen bag to avoid contact of the tumor with the surgical wound. By avoiding a laparotomy and thoracotomy, the patient can benefit from a decrease in postoperative pain, shortened hospital stay, and earlier return to daily activities.

We still advocate the combined thoracoscopic and laparoscopic esophagectomy approach for patients with intrathoracic esophageal carcinoma. However, in selected cases, the minimally invasive Ivor Lewis esophagectomy represents a feasible alternative to conventional thoracotomy and laparotomy. The indications for minimally invasive Ivor Lewis esophagectomy are (1) distal esophageal cancer with tumor extension into the gastric cardia and (2) patients with a shortened gastric conduit as a result of earlier gastric surgery. The current limitation of this technique is the difficulty in creating the intrathoracic esophagogastric anastomosis. Further experience in this anastomosis technique is needed to determine the best method of thoracoscopic reconstruction (stapled or hand-sewn).

TerryV

THE - our surgeon
Joel,

Just met with Nick's surgeon and ask how many nodes are typically removed in his surgeries. He said that in my husband's case - the original PET showed a couple enlarged nodes, not possibly not cancerous - they will take the nodes that surround the removed tissue. Typically 5 - 25.

Terry
Wife of Nick, Stage 3

preacherchad

Correction
They had stated at the beginning they would remove 40 nodes. I talked to my wife last night, and she said they only remove 25. The three closest to the tumor were positive, which showed in the scans at the very beginning.

Sorry for the false information, but I don't remember the conversation with the surgeon after surgery.


chad

Joel C

preacherchad said:

Correction
They had stated at the beginning they would remove 40 nodes. I talked to my wife last night, and she said they only remove 25. The three closest to the tumor were positive, which showed in the scans at the very beginning.

Sorry for the false information, but I don't remember the conversation with the surgeon after surgery.


chad

Great Info for those going forward!

I’m no doctor or even a statistician but I do have a pretty good grasp of the obvious and there certainly appears to be a lot of value in having as many nodes removed as possible. This is of no consequence to us that have already had the operation but for the people that are preparing for the surgery I would definitely put this on your short list of questions when talking to the surgeon. I wish I had thought about this a year ago.

In regard to cuts from the operation I have a bunch of the ¾” cuts that William refers to, I’m not sure how many as I’ve never actually counted them. But I do have two larger cuts on my back just below my shoulder blade. They measure ~2.5” & 3.5” and run parallel to each other. I was told the surgery was a minimally invasive Ivor Lewis.
Joel

jthomas233

jthomas233 said:

"Minimally Invasive Ivor Lewis"
I'm actually having a "minimally invasive Ivor Lewis", which is much like what Lukitech does, only they make the larger cut in the right chest area. That's where they do the anastomosis.

There are puts and takes to both, and the description of the surgery I am having can be found here.

http://ats.ctsnetjournals.org/cgi/content/full/72/2/593

Here is a small excerpt-

Ivor Lewis esophagectomy consists of a laparotomy and right thoracotomy for resection of the esophagus with an intrathoracic esophagogastric reconstruction [2]. Advantages of this technique are the ability to perform a complete mediastinal lymphadenectomy and a good exposure of the mediastinal esophagus to obtain surgical hemostasis. In addition, a wide resection of the gastric cardia is possible, because the anastomosis is performed in the right chest. Disadvantages of the Ivor Lewis approach are the need for single lung ventilation, morbidity associated with a thoracotomy, and the potential for a life-threatening condition if a postoperative anastomotic leak occurs.

Our minimally invasive Ivor Lewis esophagectomy is similar to the operation originally described by Lewis [2] but, instead of a laparotomy and a right thoracotomy incision, we used laparoscopy and thoracoscopy. In the first stage, we commenced with laparoscopy and mobilization of the gastric conduit. The second stage consisted of thoracoscopic mobilization of the esophagus, removal of the esophagogastric specimen, and creation of an intrathoracic anastomosis. Important technical points to emphasize are (1) divide the stomach 2 cm to 3 cm below the gastroesophageal mass to ensure a negative margin of resection, (2) perform a Kocher maneuver to gain length of the gastric conduit, and (3) remove the surgical specimen using a specimen bag to avoid contact of the tumor with the surgical wound. By avoiding a laparotomy and thoracotomy, the patient can benefit from a decrease in postoperative pain, shortened hospital stay, and earlier return to daily activities.

We still advocate the combined thoracoscopic and laparoscopic esophagectomy approach for patients with intrathoracic esophageal carcinoma. However, in selected cases, the minimally invasive Ivor Lewis esophagectomy represents a feasible alternative to conventional thoracotomy and laparotomy. The indications for minimally invasive Ivor Lewis esophagectomy are (1) distal esophageal cancer with tumor extension into the gastric cardia and (2) patients with a shortened gastric conduit as a result of earlier gastric surgery. The current limitation of this technique is the difficulty in creating the intrathoracic esophagogastric anastomosis. Further experience in this anastomosis technique is needed to determine the best method of thoracoscopic reconstruction (stapled or hand-sewn).

William
William

After re reading your last post about how your doc now does the bigger cut on the side, it sounds like i'm getting the same thing dr. L. does now. My surgeon called Luketich the "father of the mIe"....says he attended many conferences with him...hope he was listening!

Jeff

christian e

JimboC said:

I had the MIE at Pittsburgh
I had the MIE at Pittsburgh on July 1st with Dr. Luketich and they removed 31 nodes. 3 came back positive so I am doing post-op chemo. I expect to return to work sometime in November.

MIE in PITTSBURGH
Jimbo C = I recently contacted Dr. Luketich and his PA. Am Stage IIB EsophCA guy looking for the RIGHT surgery and RIGHT surgeon.
Having reviewed the literature in depth - looks like JL is the man and his MIE approach is preferable to open procedure. Have finished 5 wks of Radiation and 5 weeks of chemo (simultaneous) at Hosp U PENN (great academic institution, with great surgeons - but primarily open TTE/THE). So my questions to you...how was your experience at PITT? How was JL? Length of your procedure? Peri-operative complications? Length of hospital stay? Projected length of recovery? Eating porterhouse steaks yet? Advice for me? And how are YOU doing?