How many lymph nodes removed during esophagectomy?

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 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!!

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

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

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

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

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).

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

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