Abstract
BackgroundThe incidence of adenocarcinoma of the esophagogastric junction (AEG) has been increasing worldwide. We investigated the clinicopathological characteristics of patients with Siewert type II and III AEGs and clarified the optimal intra-abdominal lymph node dissection in these patients.MethodsThis study included 132 patients with AEG who underwent curative resection at Shizuoka Cancer Center from September 2002 to December 2012. We used the index of estimated benefit from lymph node dissection (IEBLD) to assess the efficacy of lymph node dissection of each station. The clinicopathological characteristics and IEBLDs of each station were compared between patients with Siewert type II and III AEGs.ResultsWe analyzed 92 patients with Siewert type II AEG and 40 patients with Siewert type III AEG. The incidence of lymph node metastasis was high in both groups (64.1 % in type II AEG and 75.0 % in type III AEG). The 5-year survival rates were similar for the patients with Siewert type II and III AEGs, at 54.0 and 53.4 %, respectively. The IEBLDs of stations located near the esophagogastric junction were generally high in both groups, while the IEBLDs of lower perigastric lymph nodes were higher in Siewert type III than in Siewert type II AEG cases.ConclusionsThe IEBLDs were similar between Siewert type II and III AEGs at all stations except for lower perigastric lymph nodes. Total gastrectomy should be selected as a standard treatment for Siewert type III AEG, whereas in Siewert type II AEG, preservation of the distal part of the stomach may be an acceptable procedure.
Highlights
The incidence of adenocarcinoma of the esophagogastric junction (AEG) has been increasing recently in bothEastern and Western countries [1]
The IEBLDs were similar between Siewert type II and III AEGs at all stations except for lower perigastric lymph nodes
Total gastrectomy should be selected as a standard treatment for Siewert type III AEG, whereas in Siewert type II AEG, preservation of the distal part of the stomach may be an acceptable procedure
Summary
The incidence of adenocarcinoma of the esophagogastric junction (AEG) has been increasing recently in bothEastern and Western countries [1]. The incidence of adenocarcinoma of the esophagogastric junction (AEG) has been increasing recently in both. In Eastern countries, westernized lifestyle habits and the increased incidence of gastroesophageal reflux disease are thought to be possible reasons, with the incidence of AEG likely to increase further [2]. Siewert type I AEG is the most prevalent type in Western countries and is generally treated as an esophageal cancer [4]. Siewert type II and type III AEGs are more common than Siewert type I AEG in Eastern countries and are mostly treated as a gastric cancer with a trans-hiatal approach [6]. The incidence of adenocarcinoma of the esophagogastric junction (AEG) has been increasing worldwide. We investigated the clinicopathological characteristics of patients with Siewert type II and III AEGs and clarified the optimal intra-abdominal lymph node dissection in these patients
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