1. The significance of extracapsular lymph node involvement in node- positive patients with adenocarcinoma of the distal oesophagus or gastro-oesophageal junction J Sultan, S Allan, N Hayes, SM Griffin Northern Oesophago-Gastric Cancer Unit, Royal Victoria Infirmary, Newcastle upon Tyne

2. Introduction 5 year survival Extracapsular lymph node involvement (ECLNI) Limited publications No UK studies

3. Aims To study the effect of ECLNI in patients undergoing subtotal oesophagectomy for ACA: 1.Proportion of patients with ECLNI 2.Cancer specific survival 1.3 year survival and stage of disease 2.Cancer specific survival using the number of nodes involved with extracapsular spread

4. Methods Prospective database Subtotal Oesophagectomy for ACA January 2006 to January 2013 (n=363) Node positive disease TNM 7 th edition SPSS version 19

5. Results Total number n = 363 Node positive disease n=180 ECLNI n = 100 Node negative disease n=183 ICLNI n = 80 27.5% with ECLNI

6. Patient data and outcome ICLNI n=80 ECLNI n=100 p value Age (years)65 0.973 M:F3.2:110.1:10.012 Neo-adjuvant chemo31.7%43.3%0.104 R0 resection98.8%94%1.000 BMI26.925.90.077 Blood transfusion7.5%5%0.452 Operation time (mins)3573600.621 Blood loss (mls)5305900.585 Critical care stay (days)220.784 Length of hospital stay (days)19170.333 Morbidity64%58%0.447 Mortality1.3%2%1.000

7. Histology ICLNI n=80 ECLNI n=100 p value Stage of disease 2b 3a 3b 3c 30% 38% 21% 11% 7% 23% 20% 50% 0.001 Venous involvement44%60%0.036 Perineural involvement50%78%0.001 Tumour differentiation Well differentiated Moderately differentiated Poorly differentiated 9% 46% 45% 2% 45% 53% 1.000

8. Histology ICLNI n=80 ECLNI n=100 p value Total number of nodes removed34 0.483 Nodal status n1 n2 n3 56% 35% 9% 24% 27% 49% 0.001 Total number of positive nodes260.001 Ratio of positive nodes:nodes removed 7%18%0.001

9. Survival p<0.001

10. Median Survival (months) ICLNI n=80 ECLNI n=100 p value Stage 2b n=31 -21.60.172 Stage 3a n=53 36.632.60.590 Stage 3b n=37 79.825.80.185 Stage 3c n=59 21.815.50.347 Overall p<0.001

11. 3 year Survival ICLNI n=80 ECLNI n=100 p value Stage 2b75%43%0.172 Stage 3a60%52%0.590 Stage 3b71%45%0.185 Stage 3c33%16%0.347 Overall p<0.001

12. Survival Overall Survival (months) 95% CI (months) p value ICLNI46.617.6 – 75.6 0.001 1 or 2 nodes with ECLNI26.017.0 – 35.0 3 – 6 nodes with ECLNI18.510.9 - 26.1 Over 7 nodes with ECLNI16.511.0 – 22.0

13. Overall survival p<0.001

14. Conclusion Extracapsular lymph node involvement in node-positive patients with adenocarcinoma of the distal oesophagus or gastro- oesophageal junction is a negative prognostic indicator and should be incorporated into the TNM classification