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

Fujitani, Kazumasa; Miyashiro, Isao; Mikata, Shoki; Tamura, Shigeyuki; Imamura, Hiroshi; Hara, Johji; Kurokawa, Yukinori; Fujita, J; Nishikawa, Kazuhiro; Kimura, Yutaka; Takiguchi, Shuji; Mori, Masaki; Doki, Yuichiro

doi:10.1007/s10120-012-0183-0

Cited by 50 publications

(39 citation statements)

References 31 publications

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“…Note that, in our series [51], as well as in Eastern reports [63,64], the rate of nodal metastasis along the greater curvature (stations 4sa-4sb-4d) is very low in Siewert type II tumors, suggesting that a gastric tube can be used for reconstruction after transthoracic esophagectomy.…”

Section: Lymph Node Metastasis and Lymphadenectomysupporting

confidence: 54%

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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Section: Lymph Node Metastasis and Lymphadenectomysupporting

confidence: 54%

Western strategy for EGJ carcinoma

et al. 2016

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“…EGJ tumors, whether of the adenocarcinoma or squamous cell carcinoma type, have the potential of metastasizing to the mediastinal, perigastric, and abdominal para-aortic lymph nodes. Details on the incidence of metastasis to regional lymph nodes of the stomach by Siewert type II tumors are shown in table 2 [7,12,13]. Lymphatic flow is mainly directed toward the abdomen; most patients with pathological node-positive disease have metastases to pericardial and lesser curvature nodes (Nos.…”

Section: Characteristics Of Egj Tumorsmentioning

confidence: 99%

Treatment Approaches to Esophagogastric Junction Tumors

Kurokawa

Sasako²,

Doki³

2013

Dig Surg

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Esophagogastric junction (EGJ) adenocarcinomas are usually classified into one of the three categories of the Siewert system. The clinicopathological features of EGJ adenocarcinomas vary according to this classification scheme. The lymphatic flow in EGJ tumors of any type is mainly toward the abdomen, and nodal metastasis to the upper or middle mediastinum from Siewert type II or III tumors is relatively uncommon. Thus, the transhiatal approach is regarded as the standard in surgery for Siewert type II or III tumors, while the transthoracic approach via a right thoracotomy is recommended for Siewert type I tumors. Chemoradiotherapy followed by surgery is regarded as the standard treatment for resectable cancer of the EGJ in Western countries, but the necessity of adding radiation therapy to preoperative chemotherapy remains unknown. In the East, postoperative adjuvant chemotherapy is the current standard of care since the survival benefit was proven in pivotal randomized trials for stage II/III gastric cancer, including adenocarcinoma of the EGJ.

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“…The suture line made by the stapling device can also function as guideline, like a fastener. Lower esophagectomy and proximal gastrectomy have been adopted for even advanced junctional cancer [17]. Double tract reconstruction was performed in this case series mainly to prevent postoperative reflux esophagitis [18].…”

Section: Discussionmentioning

confidence: 99%

Laparoscopic mediastinal dissection via an open left diaphragm approach for advanced Siewert type II adenocarcinoma

et al. 2015

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Around the lower esophagus, the diaphragm obstructs the laparoscopic dissection of mediastinal lymph nodes in surgery for Siewert type II cancer. To address this problem, we developed the open left diaphragm approach. After dissecting the esophageal hiatus along the diaphragm, the anterior mediastinum is dissected along the pericardium. The left side of the mediastinal pleura is then opened and the left diaphragm is incised with a 60-mm linear stapler to create sufficient working space in the lower mediastinum for the lower mediastinal lymph nodes to be resected with a good view. Six patients who received neoadjuvant chemotherapy underwent mediastinal dissection using this technique. The median operative time and estimated blood loss were 479 (390-750) min and 250 (130-500) ml, respectively, and there were no deaths or severe complications. The open left diaphragm approach provides clear surgical space and a good view for performing mediastinal lymph node dissection and is useful for laparoscopic mediastinal dissection and reconstruction.

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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

Cited by 50 publications

References 31 publications

Western strategy for EGJ carcinoma

Western strategy for EGJ carcinoma

Treatment Approaches to Esophagogastric Junction Tumors

Laparoscopic mediastinal dissection via an open left diaphragm approach for advanced Siewert type II adenocarcinoma

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