Esophagectomy for patients with resectable esophageal cancer and cervical lymph node metastases

Rationale: There is no world wide consensus on the oncological benefit versus increased morbidity associated with three field lymphadenectomy in patients with esophageal cancer and cervical lymph node metastases. In Asian countries, esophagectomy is commonly combined with a three field lymphadenectomy, including resection of cervical, thoracic and abdominal lymph nodes. However, in Western countries patients with cervical lymph node metastases are generally precluded from curative treatment.

Objective: To assess the safety and feasibility of curative esophagectomy combined with three field lymphadenectomy after chemo-radiation in Western patients with resectable thoracic esophageal carcinoma and cervical lymph node metastases.
Secondary objective is to determine the effect on survival and recurrence.

Study design: Mono centre prospective single-arm feasibility trial.

Study population: Western patients diagnosed with resectable (cT1-4a, N0-3) intra thoracic esophageal carcinoma with histological or cytological proven cervical lymph node metastases.

Intervention: Transthoracic esophageal resection combined with three field lymphadenectomy.

Main study parameters/ endpoints: Primary outcome is the percentage of overall complications grade 3b and higher as stated by the Modified Clavien-Dindo classification. Secondary outcomes are mortality, operation related events and postoperative recovery, disease free survival, overall survival and if applicable the location of recurrent disease.

Nature and extent of the burden and risks associated with participation, benefit and group relatedness: The additional burden for the patient consists of an esophagectomy combined with three field lymph node dissection including thoracic, abdominal, and bilateral cervial level II, II, and IV (parajugular and posterior triangle) lymph node dissection. Pre-operative evaluation will be performed according to general practice. Postoperative care and outpatient visits do not differ from regular protocol. The study is associated with a high risk classification. As there is a potential survival benefit, we consider the additional burden and risks justified. This study is designed as a one group study, which eliminates group relatedness.

Transthoracic esophageal resection combined with three field lymphadenectomy for patients with esophageal cancer and proven cervical lymph node metastasis is feasible and safe and might result in better survival rates.

- Peri-operative

- Post-operative during hospital admission

- During follow up period of 5 years. (fist year post surgery every 3 months, second year every 6 months, third, fourth and fifth year once every year)

Transthoracic esophageal resection combined with three field lymphadenectomy.