2. Fig. 1: Regional abdominal lymph node dissection during 2-field LND. Fig. 2: full mobilisation of spleen and pancreatic tail to allow complete LND of splenic artery and hilus. 11 v. porta v.cava inf. celiac trunk aorta 8 9 7 spleen celiac trunk 11 pancreas Gastric tube 10 8 9 1 2 3 4 5 6 7 8 9 11 10 Therapeutic impact of regional abdominal lymphadenectomy in esophageal cancer surgery. Decker G., Moons J, Coosemans W, Decaluwé H, De Leyn P, Nafteux P, Van Raemdonck D, Lerut T. University Hospitals Leuven, UZ- Gasthuisberg, KU Leuven, B-3000 Leuven Introduction Curative esophageal cancer surgery with 2-field lymph node dissection (LND) classically includes regional abdominal LND of stations 7 (left gastric artery); 8 (common hepatic artery); 9 (celiac artery); 10 (splenic hilus) and 11 (splenic artery nodes). Recent literature reviews however show that many centers currently omit removal of these regional perigastric lymph nodes especially when performing “minimally invasive” esophagectomy (MIE) (1). This could compromise the accuracy of staging and increase the risk for locoregional tumor recurrence. We therefore analysed the frequency of lymph node involvement in these stations and its prognostic impact on survival. Material & Methods Our prospective database was analysed for frequency of regional abdominal lymph node involvement and its impact on staging and survival. Results Between 1991 and 2006, 800 patients (67% adenocarcinoma, 33% squamous cell carcinoma (SqCC)) undergoing curative resection for cancer of the thoracic esophagus and gastroesophageal junction (GEJ) had at least one LN analysed from stations 7 to 11. 500 patients (67%) had at least one positive LN (pN1). 160 patients (32%) had at least one positive LN in stations 7 to 11 and at least one other positive in another lymph node station. Twenty-one patients (4.2%) had LN involvement exclusively limited to LN stations 7 to11. Of these 4 were SqCC and 17 were adenocarcinoma (9 distal third and 8 GEJ tumors). Overall 5 and 10-year survivals for N0 patients were 60.8% respectively 44.2%. 5-year survival of the 160 patients with LN involvement in position 7 to 11 plus any other station was 25%. Patients with LN involvement limited to positions 7 to 11 had a higher 5-year survival rate of 45.7% (p=0.006). In multivariate regression analysis (Cox), station 7 to 11 LN involvement was an independent prognostic survival variable (p=0.0027). Conclusions 1) Regional abdominal LND improves the precision of pathological staging. Omitting it, we would have missed N1 status in 4.2% of our patients. 2) Excellent survival of the patients with N1 disease limited to regional abdominal lymph nodes suggests that these LN stations should be considered regional (N+) rather than distant (M+) node metastasis. References: 1) Akiyama et al. Radical lymph node dissection for cancer of the thoracic esophagus. Ann Surg 1994 ; 220: 364-73. 2) Decker G. et al. Literature review on minimally invasive esophagectomy. Eur J Cardio-thoracic Surg; in press.