Mediastinal lymph node metastasis and recurrence in adenocarcinoma of the esophagogastric junction

Kurokawa, Yukinori; Hiki, Naoki; Yoshikawa, Takaki; Kutsukake, Kentaro; Ito, Y.; Ohi, Masaki; Wada, Noriko; Takiguchi, Shuji; Mine, Shinji; Hasegawa, Shin; Matsuda, Tatsuo; Takeuchi, Hiroya

doi:10.1016/j.surg.2014.08.099

Cited by 98 publications

(102 citation statements)

References 15 publications

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“…If we changed our approach to include only a laparotomy (laparoscopy) in patients with tumors affecting ≤ 3 cm of the esophagus, it appears that it would not impair survival outcomes and would reduce postoperative complications. However, Siewert type II AEG with ≥ 2 cm esophageal invasion is associated with metastasis to lower mediastinal LNs[24]. No standard surgical approach has been defined for AEG with esophageal invasion of > 3 cm.…”

Section: Discussionmentioning

confidence: 99%

Optimal treatment for Siewert type II and III adenocarcinoma of the esophagogastric junction: A retrospective cohort study with long-term follow-up

Hosoda¹,

Yamashita²,

Moriya³

et al. 2017

WJG

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AIMTo determine the optimal treatment strategy for Siewert type II and III adenocarcinoma of the esophagogastric junction.METHODSWe retrospectively reviewed the medical records of 83 patients with Siewert type II and III adenocarcinoma of the esophagogastric junction and calculated both an index of estimated benefit from lymph node dissection for each lymph node (LN) station and a lymph node ratio (LNR: ratio of number of positive lymph nodes to the total number of dissected lymph nodes). We used Cox proportional hazard models to clarify independent poor prognostic factors. The median duration of observation was 73 mo.RESULTSIndices of estimated benefit from LN dissection were as follows, in descending order: lymph nodes (LN) along the lesser curvature, 26.5; right paracardial LN, 22.8; left paracardial LN, 11.6; LN along the left gastric artery, 10.6. The 5-year overall survival (OS) rate was 58%. Cox regression analysis revealed that vigorous venous invasion (v2, v3) (HR = 5.99; 95%CI: 1.71-24.90) and LNR of > 0.16 (HR = 4.29, 95%CI: 1.79-10.89) were independent poor prognostic factors for OS.CONCLUSIONLN along the lesser curvature, right and left paracardial LN, and LN along the left gastric artery should be dissected in patients with Siewert type II or III adenocarcinoma of the esophagogastric junction. Patients with vigorous venous invasion and LNR of > 0.16 should be treated with aggressive adjuvant chemotherapy to improve survival outcomes.

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Section: Discussionmentioning

confidence: 99%

Optimal treatment for Siewert type II and III adenocarcinoma of the esophagogastric junction: A retrospective cohort study with long-term follow-up

Hosoda¹,

Yamashita²,

Moriya³

et al. 2017

WJG

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“…The most frequent sites of lymph node metastasis in carcinoma of the EGJ differ from carcinomas in other portions of the gastric tract and esophageal cancers, and a thoracic approach is sometimes taken during surgery. For this reason, unusual procedures (including lymph node dissection) and reconstruction methods are frequently required [3][4][5][6]. To date, the therapeutic strategy has not been fully established for carcinoma of the EGJ.…”

Section: Introductionmentioning

confidence: 99%

A Case of Alpha-Fetoprotein-Producing Adenocarcinoma of the Esophagogastric Junction in which Long-Term Survival Was Achieved by Means of Individualized Multidisciplinary Therapy

Tanaka

Fujiya

Ijiri

et al. 2018

J Gastrointest Canc

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“…Interestingly, as the rate of mediastinal node metastasis increases with increasing esophageal invasion [65][66][67], some authors suggest that the risk of upper-mid mediastinal node metastasis should be evaluated based on the extent of esophageal invasion, in order to limit transthoracic esophagectomies in EGJ tumor cases, which have a consistent risk of nodes that are not dissectable through an exclusive abdominal approach. Specifically, Eastern authors [68] reported a significantly higher risk of metastases in right paratracheal, subcarinal, and aortopulmonary window nodes if the esophageal invasion is more than 3 cm.…”

Section: Lymph Node Metastasis and Lymphadenectomymentioning

confidence: 98%

Western strategy for EGJ carcinoma

et al. 2016

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In this paper, the epidemiological and clinicobiological behavior of esophagogastric junction (EGJ) adenocarcinoma in the West is compared and contrasted to that in the East, and an overview is provided of current therapeutic strategies employed for this type of tumor in Western countries. It is well known that multimodal treatment is the therapeutic standard in locally advanced EGJ adenocarcinoma, but whether neoadjuvant/perioperative chemotherapy (CT) or neoadjuvant chemoradiotherapy (CRT) is the optimal approach is still debated. Neoadjuvant CRT improves local control in locally advanced Siewert type I and II tumors, so it should be considered the treatment of choice. In the subset of these patients with microscopic systemic disease at diagnosis, more intensive exclusive chemotherapy protocols could be of benefit. Therefore, there is an urgent need to identify these patients before planning the treatment. For Siewert type III tumors, perioperative chemotherapy is the standard. While there is general agreement on the optimal surgical approach for Siewert types I and III (a two-field Ivor Lewis operation and a total gastrectomy with distal esophagectomy, respectively), no standard surgical treatment has been defined for Siewert type II tumors. When data from Western series on proximal and circumferential resection margins and on nodal spread in Siewert type II tumors are taken into account, the optimal surgical approach appears to be Ivor Lewis esophagectomy. Whether the extent of esophageal invasion can correctly predict nodal involvement in middle-upper mediastinal stations as a means to restrict indications for transthoracic esophagectomy requires further investigation in the West.

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Mediastinal lymph node metastasis and recurrence in adenocarcinoma of the esophagogastric junction

Cited by 98 publications

References 15 publications

Optimal treatment for Siewert type II and III adenocarcinoma of the esophagogastric junction: A retrospective cohort study with long-term follow-up

Optimal treatment for Siewert type II and III adenocarcinoma of the esophagogastric junction: A retrospective cohort study with long-term follow-up

A Case of Alpha-Fetoprotein-Producing Adenocarcinoma of the Esophagogastric Junction in which Long-Term Survival Was Achieved by Means of Individualized Multidisciplinary Therapy

Western strategy for EGJ carcinoma

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