Nodal abdominal spread in adenocarcinoma of the cardia. Results of a multicenter prospective study

Manzoni, Giovanni De; Morgagni, Paolo; Roviello, Franco; Leo, Alberto Di; Saragoni, Luca; Marrelli, Daniele; Guglielmi, Alfredo; Carli, Anton Ferdinando; Folli, Secondo; Cordiano, Claudio

doi:10.1007/s101200050009

Cited by 30 publications

(25 citation statements)

References 24 publications

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“…1, in which metastatic nodal spread was seen in 80 % of patients with a striking contrast in the frequency between the perigastric nodes of the upper half of the stomach in positions 1-3 and those of the lower half of the stomach in positions 4d-6. With regard to the second-tier stations, lymph nodes along the left gastric artery (station 7) were affected in a substantial percentage of patients (18-65 %) with type II tumors in previous reports [5,[17][18][19][20][21][22], which was compatible with our findings shown in Fig. 1.…”

Section: Discussionsupporting

confidence: 93%

“…1 Frequency of nodal involvement to each abdominal lymph node station for the 86 patients under study. Lymph node stations are classified according to Japanese criteria 17 In this study, long-term survival was mostly limited to the patients with fewer than 7 metastatic nodes, and the independent prognostic value of nodal involvement was demonstrated in the multivariate analysis. Similar to these results, the involvement of second-tier lymph nodes [6,10,23] and the presence of more than 6 metastatic nodes [18,19,21] have already been reported as negative prognostic factors in GEJ adenocarcinoma.…”

Section: Discussionmentioning

confidence: 95%

“…There have been several reports regarding the pattern of abdominal lymph node spread of Siewert type II adenocarcinoma [17][18][19][20]. Italian investigators reported that 44 of 62 patients (71 %) with pT2-4 Siewert type II tumors had lymph node metastases, and a high frequency of nodal involvement in the perigastric nodes of the upper half of the stomach (right paracardial 50 %, left paracardial 32 %, lesser curvature 53 %) was seen, in contrast to the fairly low percentage of metastases in the lymph nodes along the right gastroepiploic artery (7 %), suprapyloric (2 %), and infrapyloric lymph nodes (2 %) [17,18].…”

Section: Discussionmentioning

confidence: 99%

“…In this study, we excluded patients with early carcinoma (pT1). In early gastric cancer of the true cardia, abdominal lymph node involvement is known to be limited to the perigastric nodes of the upper half of the stomach and the lymph nodes of the celiac trunk [17]. Based on these patterns of abdominal nodal spread and the virtual absence of lymph node metastases, a limited resection of the distal esophagus, cardia, and proximal stomach is commonly performed and is considered to provide adequate disease control for early carcinoma of the true cardia [26].…”

Section: Discussionmentioning

confidence: 99%

“…On the other hand, there have been some controversies regarding the appropriate extent of gastric resection and the therapeutic value of extended lymphadenectomy for the treatment of advanced adenocarcinoma of the cardia [3,13,17,19,20]. Some investigators advocate total gastrectomy because of the possible metastasis to the distal perigastric stations numbered 4d, 5, and 6 [3,17].…”

Section: Discussionmentioning

confidence: 99%

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Pattern of abdominal nodal spread and optimal abdominal lymphadenectomy for advanced Siewert type II adenocarcinoma of the cardia: results of a multicenter study

et al. 2012

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Background It remains uncertain whether radical lymphadenectomy combined with total gastrectomy actually contributes to long-term survival for Siewert type II adenocarcinoma of the cardia. We identified the pattern of abdominal nodal spread in advanced type II adenocarcinoma and defined the optimal extent of abdominal lymphadenectomy. Methods Eighty-six patients undergoing R0 total gastrectomy for advanced type II adenocarcinoma were identified from the gastric cancer database of 4,884 patients. Prognostic factors were investigated by multivariate analysis. The therapeutic value of lymph node dissection for each station was estimated by multiplying the incidence of were considered not beneficial to dissect, whereas there were substantial therapeutic benefits to dissecting the perigastric nodes of the upper half of the stomach in positions 1-3 and the second-tier nodes in positions 7 and 11. Conclusions Limited lymphadenectomy attained by proximal gastrectomy might suffice as an alternative to extended lymphadenectomy with total gastrectomy for obtaining On behalf

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Section: Discussionsupporting

confidence: 93%

Section: Discussionmentioning

confidence: 95%

Section: Discussionmentioning

confidence: 99%

Section: Discussionmentioning

confidence: 99%

Section: Discussionmentioning

confidence: 99%

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Pattern of abdominal nodal spread and optimal abdominal lymphadenectomy for advanced Siewert type II adenocarcinoma of the cardia: results of a multicenter study

et al. 2012

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Surgical resection for cancer of the cardia

Siewert

Stein

Sendler

et al. 1999

Semin. Surg. Oncol.

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From the pathogenic and therapeutic point of view, adenocarcinomas of the esophagogastric junction (AEG) should be classified into adenocarcinoma of the distal esophagus (Type I), true carcinoma of the cardia (Type II), and subcardial carcinoma (Type III). This classification can be easily performed by summarizing the information available from contrast radiography, endoscopy, and intra‐operative findings; it allows comparison of data between various centers and facilitates the choice of surgical therapy. A complete removal of the primary tumor and its lymphatic drainage has to be the primary goal of any surgical approach to adenocarcinoma of the esophagogastric junction. In patients with potentially resectable, true carcinoma of the cardia (AEG Type II), this can be achieved by a total gastrectomy with transhiatal resection of the distal esophagus and en bloc removal of the lymphatic drainage in the lower posterior mediastinum and along the celiac axis and superior border of the pancreas. This approach is associated with lower morbidity and provides equal long‐term survival as compared to the more radical transmediastinal or abdominothoracic esophagogastrectomy. Whether a routine splenectomy for lymphadenectomy in the splenic hilus offers a survival benefit in these patients is questionable. In patients with early tumors staged as uT1 on pre‐operative endosonography, a limited resection of the proximal stomach, cardia, and distal esophagus with interposition of a pedicled isoperistaltic jejunal segment appears justified since this procedure allows a complete tumor removal with adequate lymphadenctomy and offers excellent functional results. Multimodal therapy with pre‐operative polychemotherapy or combined radio‐chemotherapy appears to offer a significant survival benefit in patients with locally advanced tumors. With this tailored approach, extensive pre‐operative staging becomes mandatory for an adequate selection of the appropriate therapeutic concept. Semin. Surg. Oncol. 17:125–131, 1999. © 1999 Wiley‐Liss, Inc.

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Patterns of recurrence after trimodality therapy for esophageal cancer

Dorth

Pura

Palta

et al. 2014

Cancer

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BACKGROUND Patterns of failure after neoadjuvant chemoradiotherapy and surgery for esophageal cancer are poorly defined. METHODS All patients in the current study were treated with trimodality therapy for nonmetastatic esophageal cancer from 1995 to 2009. Locoregional failure included lymph node failure (NF), anastomotic failure, or both. Abdominal paraaortic failure (PAF) was defined as disease recurrence at or below the superior mesenteric artery. RESULTS Among 155 patients, the primary tumor location was the upper/middle esophagus in 18%, the lower esophagus in 32%, and the gastroesophageal junction in 50% (adenocarcinoma in 79% and squamous cell carcinoma in 21%) of patients. Staging methods included endoscopic ultrasound (73%), computed tomography (46%), and positron emission tomography/computed tomography (54%). Approximately 40% of patients had American Joint Committee on Cancer stage II disease and 60% had stage III disease. The median follow-up was 1.3 years. The 2-year locoregional control, event-free survival, and overall survival rates were 86%, 36%, and 48%, respectively. The 2-year NF rate was 14%, the isolated NF rate was 3%, and the anastomotic failure rate was 6%. The 2-year PAF rate was 9% and the isolated PAF rate was 5%. PAF was found to be increased among patients with gastroesophageal junction tumors (12% vs 6%), especially for the subset with ≥2 clinically involved lymph nodes at the time of diagnosis (19% vs 4%). CONCLUSIONS Few patients experience isolated NF or PAF as their first disease recurrence. Therefore, it is unlikely that targeting additional regional lymph node basins with radiotherapy would significantly improve clinical outcomes.

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Nodal abdominal spread in adenocarcinoma of the cardia. Results of a multicenter prospective study

Cited by 30 publications

References 24 publications

Pattern of abdominal nodal spread and optimal abdominal lymphadenectomy for advanced Siewert type II adenocarcinoma of the cardia: results of a multicenter study

Pattern of abdominal nodal spread and optimal abdominal lymphadenectomy for advanced Siewert type II adenocarcinoma of the cardia: results of a multicenter study

Surgical resection for cancer of the cardia

Patterns of recurrence after trimodality therapy for esophageal cancer

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