Abstract
BackgroundRecently, the incidence of gastroesophageal junction (GEJ) cancer has been increasing in Eastern countries. Mediastinal lymph node (MLN) metastasis rates among patients with GEJ cancer are reported to be 5–25%. However, survival benefits associated with MLN dissection in GEJ cancer has been a controversial issue, especially in Eastern countries, due to its rarity and potential morbidity.MethodsWe retrospectively reviewed 290 patients who underwent surgery for GEJ cancer at the National Cancer Center in Korea from June 2001 to December 2015. Clinicopathologic characteristics and surgical outcomes were compared between patients without MLN dissection (Group A) and patients with MLN dissection (Group B). Prognostic factors associated with the survival rate were identified in a multivariate analysis.ResultsTwenty-nine (10%) patients underwent MLN dissection (Group B). Three of 29 patients (10.3%) showed a metastatic MLN in Group B. The 5-year disease-free survival rate was 79.5% in Group A and 33.9% in Group B (P < 0.001). The multivariate analysis revealed that abdominal LN dissection, pT category, and pN category were statistically significant prognostic factors. LNs were the most common site for recurrence in both groups.ConclusionAbdominal LN dissection and pathologic stage are the important prognostic factors for type II and III GEJ cancer rather than mediastinal lymph node dissection.
Highlights
The incidence of gastroesophageal junction (GEJ) cancer has been increasing in Eastern countries
The 8th edition classifies Siewert type II as esophageal cancer, and Siewert type III was changed to gastric cancer [5]
We investigated the optimal extent of LN dissection in GEJ cancer via the analysis of the distribution of lymph node metastasis, prognostic factors and recurrence patterns in GEJ cancer
Summary
The incidence of gastroesophageal junction (GEJ) cancer has been increasing in Eastern countries. Survival benefits associated with MLN dissection in GEJ cancer has been a controversial issue, especially in Eastern countries, due to its rarity and potential morbidity. While gastroesophageal junction (GEJ) cancer has been commonly observed in Western countries, the incidence of GEJ cancer is still rare but has been increasing in Eastern countries in recent years [1, 2]. There is a controversy regarding whether GEJ cancer should be classified as gastric or esophageal cancer [4]. The 8th edition (published in 2017) classifies Siewert type II as esophageal cancer, and Siewert type III was changed to gastric cancer [5]. MLN dissection is rarely performed in Eastern countries due to the rarity of type I and its invasiveness and associated morbidity. Whether MLN dissection has survival benefits has been a debatable issue. [6, 10,11,12,13]
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