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Role of Lymphadenectomy in Surgical Treatment of Solid Tumors: An Update on the Clinical Data

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Abstract

Background

The role of lymphadenectomy as an adjunct of standard excision for treatment of cancer is highly debated and controversial. Standard practice for treatment of solid tumors is resection with regional lymphadenectomy. This surgical concept assumes that cancers grow and spread in an orderly manner, from primary cancer to regional lymph nodes and finally to vital organs. We reviewed randomized trials, published a description of lymphatic anatomy and physiology, and presented data that disputed the role of lymphadenectomy as standard practice. The present review updates the literature and reiterates the concept that lymphadenectomy does not increase survival in the surgical treatment of solid tumors.

Methods

We reviewed the English-language literature (Medline) for prospective randomized trials and nonrandomized reports, as well as retrospective studies addressing the role of lymphadenectomy in cancers of the esophagus, lung, stomach, pancreas, breast, and skin (melanoma) reported between 2000 and 2006.

Results

This extensive review demonstrates that there are few prospective randomized trials assessing patient survival with solid tumors that contrast resection with or without lymphadenectomy. However, there was at least one, and for some cancers more than one, prospective randomized trial for each organ site studied, and the data demonstrate no statistically significant difference in overall survival of patients treated with or without lymphadenectomy. Most nonrandomized and retrospective studies, with a few exceptions, support the conclusions of randomized trials; lymphadenectomy does not improve overall survival in solid tumors. Overall survival is primarily a function of the biological nature of the primary tumor, as evidenced by lymphovascular invasion, lymph node involvement, and other prognostic features.

Conclusions

This extensive literature review of recent reports indicates that lymphadenectomy does not improve overall survival. Lymph node resection should be conceived in terms of staging, prognosis, and regional control only.

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Authors and Affiliations

  1. Department of Surgery, Seton Hall University at St. Francis Medical Center, 601 Hamilton Avenue, Trenton, New Jersey, 08629, USA

    Samer Sbayi MD

  2. Department of Surgery, Brown Medical School, Comprehensive Breast Center, Rhode Island Hospital, 593 Eddy Street, APC 4, Providence, Rhode Island, 02903, USA

    Blake Cady MD, FACS

  3. Department of Surgery, Saint Peter’s University Hospital, 254 Easton Ave, New Brunswick, New Jersey, 08901, USA

    James E. Gervasoni Jr. PhD, MD, FACS

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  1. James E. Gervasoni Jr. PhD, MD, FACS
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  2. Samer Sbayi MD
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  3. Blake Cady MD, FACS
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Correspondence to James E. Gervasoni Jr. PhD, MD, FACS.

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Jr., J.E.G., Sbayi, S. & Cady, B. Role of Lymphadenectomy in Surgical Treatment of Solid Tumors: An Update on the Clinical Data. Ann Surg Oncol 14, 2443–2462 (2007). https://doi.org/10.1245/s10434-007-9360-5

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