Abstract
AimThe aim of the present study was to clarify esophagogastric junction (EGJ) carcinoma patients who are at high risk of upper and middle mediastinal lymph node (MLN) metastasis.MethodsThis was a retrospective study and included 110 consecutive patients with EGJ carcinoma who underwent R0/R1 resection at Keio University Hospital between January 2000 and December 2013.ResultsOf the 110 patients, 18 (16.3%) had MLN metastasis, and the number increased to 23 (20.9%) when recurrence cases were added (adenocarcinoma, N = 11; squamous cell carcinoma, N = 12). Patients whose tumor epicenter was located above the EGJ had a significantly higher incidence of MLN metastasis/recurrence (18/51 [35.3%]) than those whose tumor epicenter was located below the EGJ (5/59 [8.5%]). The MLN metastasis/recurrence rate was particularly high when the distance from the EGJ to the proximal edge of the primary tumor was >3 cm for the upper and middle mediastinum (18.8%). Patients in a selected group (≥T2 and tumor epicenter located above the EGJ or below the EGJ with ≥3 cm esophageal invasion) showed 17.9% and 15.4% upper and middle MLN metastasis/recurrence rates, respectively. Therapeutic value of MLN dissection was relatively high (#105 + 106: 8.9, #110: 12.2).ConclusionsTherapeutic value of MLN dissection to treat EGJ carcinomas was relatively high in patients with MLN metastasis. Our algorithm could select patients at high risk for MLN metastasis.
Highlights
The incidence of esophagogastric junction (EGJ) carcinoma has increased around the world,[1,2,3] including Japan
We created a surgical algorithm for the treatment of EGJ carcinoma, including AC and Squamous cell carcinoma (SCC), which includes three important factors: location of the tumor epicenter, T factor status, and length of esophageal invasion (Figure 2)
Tumor location and T‐factor status were the first two steps in this algorithm as multivariate analysis showed that tumor center location and pT status were related to mediastinal lymph node (MLN) metastasis
Summary
The incidence of esophagogastric junction (EGJ) carcinoma has increased around the world,[1,2,3] including Japan. A transthoracic approach is carried out for patients with Siewert type I tumors, whereas the transhiatal approach is used for those with Siewert type III tumors. Nishi's classification of EGJ carcinoma has been used in Japan.[15] This definition describes EGJ carcinoma as a tumor whose tumor epicenter is located within a 2‐cm area above and below the EGJ, regardless of histological type. This classification includes both histological types, most patients with AC have received a resection of the lower esophagus and stomach, whereas those with SCC have undergone subtotal esophagectomy, reflecting differences in the dominant tumor location
Sign-in/Register to view highlights & summary Sign-in/Register to access full text options 
Talk to us
Join us for a 30 min session where you can share your feedback and ask us any queries you have
Schedule a callDisclaimer: All third-party content on this website/platform is and will remain the property of their respective owners and is provided on "as is" basis without any warranties, express or implied. Use of third-party content does not indicate any affiliation, sponsorship with or endorsement by them. Any references to third-party content is to identify the corresponding services and shall be considered fair use under The CopyrightLaw.
