Vol. 4 No. 1 (2021): American Journal of Surgical Research and Reviews

Impact of tumor size on depth of invasion and number of Lymph nodes infiltration in esophageal cancer

Ahmed S Elgammal1, Ihab S Ahmed2, Walla Abdelgawad3, Essam Elshiekh4
1General surgery department, Menofia faculty of medicine, Menofia University, Egypt. 2Surgical oncology department, NCI, Cairo university, Egypt. 3Pathology department, Suez faculty of medicine, Suez university, Egypt. 4Surgical oncology department, Tanta Cancer Center, Egypt.


  • esophageal carcinoma, Lymph nodes, depth of invasion, tumor size

How to Cite

Ahmed S Elgammal1, Ihab S Ahmed2, Walla Abdelgawad3, Essam Elshiekh4. (2021). Impact of tumor size on depth of invasion and number of Lymph nodes infiltration in esophageal cancer. American Journal of Surgical Research and Reviews, 4(1), 26. https://doi.org/10.28933/ajsrr-2021-06-0305


Introduction: Esophageal cancer (EC) is one of the deadliest malignancies worldwide and is often diagnosed in advanced stages. It is the 8th most common cancer in the world and is the 6th most common cause of cancer related deaths, having a 5-year survival rate of less than 20% despite advances in treatment. It has a poor prognosis due to the late diagnosis and the lack of early presenting symptoms. In the United States, stage IV is the most common stage at the time of diagnosis.

Methods: Eighty-seven fit patients were recruited for this multi-institutional clinical prospective study in the period from the start of January 2014 to the end of December 2020, diagnosed as cancer esophagus in by endoscopic biopsy and underwent surgical treatment according to stage at the centers participating in this study.

Results: In pre-operative biopsy, Adenocarcinoma was diagnosed in 39/87 cases (44.8%) distributed as (5 in GEJ and 34 diagnosed in lower esophagus) while squamous cell carcinoma (SCC) diagnosed in 48/87 cases (55.2%) distributed as (28 in lower part, 10 in middle part and 9 in upper esophagus respectively) and only one case out of 87 cases diagnosed as undifferentiated carcinoma of lower esophagus. We found significant association between the increased tumor size and the increase depth of invasion and thenumber of harvested lymph nodes.

Conclusion: As the tumor size increased (cutoff point 3cm), the depth of invasion through the layers of esophagus and the number of the infiltrated lymph nodes will increase, and this is associated with poor prognosis and increase in mortality rate from the esophageal cancer.


  1. Patel N, Benipal B. Incidence of esophageal cancer in the United States from 2001?2015: United States Cancer Statistics Analysis of 50 states. Cureus. 2018; 10(12): e3709. Pub-Med Web of Science®Google Schol-ar https://doi.org/10.1002/jso.25656
  2. Xie SH, Lagergren J. Risk factors for esopha-geal cancer. Best Pract Res Clin Gastroenter-ol. 2018; 36?37: 3? 8. CrossRef PubMed Web of Science®Google Scholar
  3. Zhang Y. Epidemiology of esophageal can-cer. World J Gastroenterol. 2013; 19 (34): 5598? 5606.
  4. CrossRef PubMed Web of Science®Google Scholar Lordick F, Mariette C, Haustermans K, et al. Esophageal cancer: ESMO clinical practice guidelines for diagnosis, treatment and fol-low-up. Ann Oncol 2016; 27: v50–v57. [PubMed] [Google Scholar]
  5. van Hagen P, Hulshof MC, van Lanschot JJ, et al. Preoperative chemo radiotherapy for esophageal or junctional cancer. N Engl J Med 2012; 366: 2074–2084. [PubMed] [Google Scholar]
  6. Noordman BJ, Verdam MGE, Lagarde SM, et al. Impact of neoadjuvant chemo radiotherapy on health-related quality of life in long-term sur-vivors of esophageal or junctional cancer: Re-sults from the randomized CROSS trial. Ann Oncol 2018; 29: 445–451. [PubMed] [Google Scholar]
  7. Lymph Node Metastases in Esophageal Carci-noma: An Endoscopist’s View. Cho JW, Choi SC, Jang JY, Shin SK, Choi KD, Lee JH, Kim SG, Sung JK, Jeon SW, Choi IJ, Kim GH, Jee SR, Lee WS, Jung HY, Korean ESD Study Group. Clin Endosc. 2014 Nov; 47(6):523-9. [PubMed] [Ref list]
  8. Chemo radiotherapy in tumors of the esophagus and gastro-esophageal junction. Hulshof MC, van Laarhoven HW Best Pract Res Clin Gastro-enterol. 2016 Aug; 30(4):551-63. [PubMed] [Ref list]
  9. Thies S, Langer R. Tumor regression grading of gastrointestinal carcinomas after neoadjuvant treatment. Front Oncol 2013; 3: 262. [PMC free article] [PubMed] [Google Scholar]
  10. Davarzani N, Hutchins GGA, West NP, et al. Prognostic value of pathological lymph node status and primary tumor regression grading following neoadjuvant chemotherapy – results from the MRC OE02 esophageal cancer tri-al. Histopathology 2018; 72: 1180–1188. [PMC free article] [PubMed] [Google Scholar
  11. Leers JM, DeMeester SR, Oezcelik A, et al. The prevalence of lymph node metastases in pa-tients with T1 esophageal adenocarcinoma a retrospective review of esophagectomy speci-mens. Ann Surg. 2011; 253:271–8. [PubMed] [Google Scholar]
  12. Significance of the depth of tumor invasion and lymph node metastasis in superficially invasive (T1) esophageal adenocarcinoma. Liu L, Hof-stetter WL, Rashid A, Swisher SG, Correa AM, Ajani JA, Hamilton SR, Wu TT Am J Surg Pathol. 2005 Aug; 29(8):1079-85. [PubMed] [Ref list]
  13. Strong VE, D’Amico TA, Kleinberg L, Ajani J. Impact of the 7th Edition AJCC staging classi-fication on the NCCN clinical practice guidelines in oncology for gastric and esophageal can-cers. J Natl Compr Canc Netw.2013;11:60–66. [PubMed] [Google Scholar
  14. Wittekind C. New TNM classification of lung tu-mors. Pathology. 2014 [PubMed] [GooglScholar]
  15. Schwartz AM, Henson DE, Chen D, Rajamar-thandan S. Histologic grade remains a prog-nostic factor for breast cancer regardless of the number of positive lymph nodes and tumor size: a study of 161 708 cases of breast cancer from the SEER Program. Arch Pathol Lab Med. 2014;138:1048–1052. [PubMed] [Google Scholar]
  16. Duseja A. Staging of hepatocellular carcino-ma. J Clin Exp Hepatol. 2014;4: S74–S79. [PMC free article] [PubMed] [Google Scholar]
  17. Edge SB, Compton CC. The American Joint Committee on Cancer: the 7th edition of the AJCC cancer staging manual and the future of TNM. Ann Surg Oncol. 2010;17:1471–1474. [PubMed] [Google Scholar
  18. Iizuka T, Isono K, Kakegawa T, Watanabe H. Parameters linked to ten-year survival in Japan of resected esophageal carcinoma. Japanese Committee for Registration of Esophageal Car-cinoma Cases. Chest. 1989; 96:1005–1011. [PubMed] [Google Scholar]
  19. Sobin LH, Hermanek P, Hutter RV. TNM classi-fication of malignant tumors. A comparison between the new (1987) and the old edi-tions. Cancer. 1988; 61:2310–2314. [PubMed] [Google Scholar]
  20. Griffiths EA, Brummell Z, Gorthi G, Pritchard SA, Welch IM. Tumor length as a prognostic factor in esophageal malignancy: univariate and multi-variate survival analyses. J Surg Oncol. 2006; 93:258–267. [PubMed] [Google Scholar]
  21. Wu N, Pang LW, Chen ZM, Ma QY, Chen G. Tumor length is an independent prognostic factor of esophageal squamous cell carcino-mas. Chin Med J (Engl) 2012;125:4445–4448. [PubMed] [Google Scholar]
  22. Wang BY, Liu CY, Lin CH, Hsu PK, Hsu WH, Wu YC, Cheng CY. Endoscopic tumor length is an independent prognostic factor in esophageal squamous cell carcinoma. Ann Surg On-col. 2012;19:2149–2158. [PubMed] [GoogleScholar]
  23. Feng JF, Huang Y, Zhao Q. Tumor length in el-derly patients with esophageal squamous cell carcinoma: is it a prognostic factor? Ups J Med Sci. 2013;118:145–152. [PMC free arti-cle] [PubMed] [Google Scholar]
  24. Bollschweiler E, Baldus SE, Schroder W, Schneider PM, Holscher AH. Staging of esophageal carcinoma: length of tumor and number of involved regional lymph nodes. Are these independent prognostic factors? J Surg Oncol. 2006; 94:355–363. [PubMed] [Google Scholar
  25. Eloubeidi MA, Desmond R, Arguedas MR, Reed CE, Wilcox CM. Prognostic factors for the sur-vival of patients with esophageal carcinoma in the U.S.: the importance of tumor length and lymph node status. Cancer. 2002; 95:1434–1443. [PubMed] [Google Scholar]
  26. Yendamuri S, Swisher SG, Correa AM, Hof-stetter W, Ajani JA, Francis A, Maru D, Mehran RJ, Rice DC, Roth JA, Walsh GL, Vaporciyan AA. Esophageal tumor length is independently associated with long-term surviv-al. Cancer. 2009; 115:508–516. [PubMed] [Google Scholar].
  27. Zeybek A, Erdogan A, Gulkesen KH, Ergin M, Sarper A, Dertsiz L, Demircan A. Significance of tumor length as prognostic factor for esopha-geal cancer. Int Surg. 2013; 98:234–240. [PMC free article] [PubMed] [Google Scholar]
  28. Bolton WD, Hofstetter WL, Francis AM, Correa AM, Ajani JA, Bhutani MS, Erasmus J, Komaki R, Maru DM, Mehran RJ, Rice DC, Roth JA, Vaporciyan AA, et al. Impact of tumor length on long-term survival of pT1 esophageal adeno-carcinoma. J Thorac Cardiovascular Surg. 2009; 138:831–836. [PubMed] [Google Scholar
  29. Zhang H, Tang P, Miao X, et al. Does tumor size improve the accuracy of prognostic prediction in patients with esophageal squamous cell carci-noma after surgical resection? Oncotarget 2016; 7:66623-34. [PMC free arti-cle] [PubMed] [Google Scholar]
  30. Duan XF, Tang P, Shang XB, et al. The preva-lence of lymph node metastasis for pathological T1 esophageal cancer: a retrospective study of 143 cases. Surg Oncol 2018; 27:1-6. 10.1016/j.suronc.2017.11.002 [PubMed] [CrossRef] [Google Scholar]
  31. Shen W, Shen Y, Tan L, et al. A nomogram for predicting lymph node metastasis in surgically resected T1 esophageal squamous cell carci-noma. J Thorac Dis 2018; 10:4178-85. 10.21037/jtd.2018.06.51 [PMC free arti-cle] [PubMed] [CrossRef] [Google Scholar
  32. Zhang H, Tang P, Miao X, et al. Does tumor size improve the accuracy of prognostic prediction in patients with esophageal squamous cell carci-noma after surgical resection? Oncotarget 2016; 7:66623-34. [PMC free arti-cle] [PubMed] [Google Scholar]