Should Splenic Hilar Lymph Nodes be Dissected for Siewert Type II and III Esophagogastric Junction Carcinoma Based on Tumor Diameter?

Abstract

The aim of the study is to identify the value of a spleen-preserving No. 10 lymphadenectomy (SPL) for Siewert type II/III adenocarcinoma of the esophagogastric junction (AEG).From January 2007 to June 2014, 694 patients undergoing radical total gastrectomy for Siewert type II/III AEG were analyzed. Oncologic outcomes were compared between SPL and no SPL (No. 10D+ and No. 10D–) groups.The incidence of No. 10 lymph node metastasis (LNM) was 12.3%. No significant differences in the incidence of No. 10 LNM were found between Siewert type II AEG with tumor diameters of <4 cm and ≥4 cm (P = 0.071). However, Siewert type III AEG with a tumor diameter ≥4 cm showed a significantly higher frequency of No. 10 LNM compared with a tumor diameter <4 cm (P < 0.001). The No. 10D+ group had superior 3-year overall survival (OS) and disease-free survival (DFS) rates compared with the No. 10D− group (P = 0.030 and P = 0.005, respectively). For patients with Siewert type II and type III AEG with a tumor diameter <4 cm, the 3-year OS and DFS rates were similar between the 2 groups. However, the No. 10D+ group had better 3-year OS (66.6% vs 51.1%, P = 0.019) and DFS (63.2% vs 45.9%, P = 0.007) rates for Siewert type III AEG with a tumor diameter ≥4 cm. A multivariate Cox regression showed that SPL was an independent prognostic factor in Siewert type III AEG with a tumor diameter ≥4 cm.SPL may improve the prognosis of Siewert type III AEG with a tumor diameter ≥4 cm, whereas SPL may be omitted without decreasing survival in patients with Siewert type II or type III AEG with a tumor diameter <4 cm.

Survival Benefit of Pyloric Lymph Node Dissection for Siewert Type II/III Adenocarcinoma of the Esophagogastric Junction Based on Tumor Diameter: A Large Cohort Study

“…This suggests that No. 10 lymphadenectomy is recommended for Siewert type III AEG with a tumor diameter >4 cm (26). Although Siewert type III cancers had more metastatic lymph nodes in this study, the metastasis rate of PLNs was comparable between Siewert type II and Siewert type III AEGs.…”

“…However, these reports do not present a detailed investigation of the IEBLDs based on tumor diameter. For all we Siewert type III AEG with a tumor diameter >4 cm (26). This suggests that No.…”

Trends in esophageal and esophagogastric junction cancer research from 2007 to 2016

“…[ 22 ] In addition, evidence suggests that spleen-preserving No.10 lymphadenectomy (SPL) may improve the prognosis of Siewert type III adenocarcinoma (tumor diameter ≥4 cm) of the EGJ, while for patients with Siewert type II or III adenocarcinoma (tumor diameter <4 cm), SPL may be omitted without reducing the survival rate. [ 23 ] Although the above-mentioned surgical approaches have some limitations, they provide new methods for the treatment of EGJ cancer.…”

Feasibility of laparoscopic gastrectomy for patients with Siewert-type II/III adenocarcinoma of the esophagogastric junction: A propensity score matching analysis

“…The results may be explained by the fact that survival time was mainly determined by the UICCs [ 5 ]. On the other hand, a previous study has demonstrated that Siewert-type III AEG with tumor diameters >4 cm has a high relative frequency of splenic hilar metastasis [ 19 ]. Therefore, AEG often combined splenic hilar resection in this study.…”