Kotaro Sugawara

Numeric pathologic lymph node classification shows prognostic superiority to topographic pN classification in esophageal squamous cell carcinoma

Background. The current eighth tumor node metastasis lymph node category pathologic lymph node staging system for esophageal squamous cell carcinoma is based solely on the number of metastatic nodes and does not consider anatomic distribution. We aimed to assess the prognostic capability of the eighth tumor node metastasis pathologic lymph node staging system (numeric‐based) compared with the 11th Japan Esophageal Society (topography‐based) pathologic lymph node staging system in patients with esophageal squamous cell carcinoma. Methods. We retrospectively reviewed the clinical records of 289 patients with esophageal squamous cell carcinoma who underwent esophagectomy with extended lymph node dissection during the period from January 2006 through June 2016. We compared discrimination abilities for overall survival, recurrence‐free survival, and cancer‐specific survival between these 2 staging systems using C‐statistics. Results. The median number of dissected and metastatic nodes was 61 (25% to 75% quartile range, 45 to 79) and 1 (25% to 75% quartile range, 0 to 3), respectively. The eighth tumor node metastasis pathologic lymph node staging system had a greater ability to accurately determine overall survival (C‐statistics: tumor node metastasis classification, 0.69, 95% confidence interval, 0.62–0.76; Japan Esophageal Society classification; 0.65, 95% confidence interval, 0.58–0.71; P = .014) and cancer‐specific survival (C‐statistics: tumor node metastasis classification, 0.78, 95% confidence interval, 0.70–0.87; Japan Esophageal Society classification; 0.72, 95% confidence interval, 0.64–0.80; P = .018). Rates of total recurrence rose as the eighth tumor node metastasis pathologic lymph node stage increased, while stratification of patients according to the topography‐based node classification system was not feasible. Conclusion. Numeric nodal staging is an essential tool for stratifying the oncologic outcomes of patients with esophageal squamous cell carcinoma even in the cohort in which adequate numbers of lymph nodes were harvested.

Reply to three Editorials by Luris N et al ., Sussmann N, and Vather R, et al .

We are grateful to read three editorials by Lluis et al ., Sussmann, and Vather, et al . (1-3) for our recent study entitled “Perioperative factors predicting prolonged postoperative ileus after major abdominal surgery” in Journal of Gastrointestinal Surgery (4). We devised a nomogram to predict the development of prolonged postoperative ileus (PPOI) based on the multivariable logistic regression analysis for patients undergoing major abdominal surgery.