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

Xia, Lin; Li, Zhengyan; Tan, Chenjun; Ye, Xiaoshuang; Xiong, Jie; Li, Jiajia; Mo, Ao; Shi, Yan; Qian, Feng; Yu, Peiwu; Zhao, Yongliang

doi:10.3389/fonc.2021.748694

Cited by 5 publications

(4 citation statements)

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“…Accordingly, the distal perigastric node dissection seemed to be unable to offer survival benefits. The findings confirmed very low metastatic rates (0.3%~2.1%) and an efficiency index (0%~0.5%), suggesting that the dissection along the lower perigastric portion was unnecessary unless in the case of tumors larger than 4.0 cm in terms of en block dissection, and also the potential benefit was observed only in a retrospective study (37). Another multicenter study of 288 patients with advanced Siewert type II carcinoma stated that the extent of metastasis to the distal perigastric nodes was associated with the distance from the EGJ to the distal end of gastric involvement (38).…”

Section: Optional Dissection Of Distal Perigastric Lymph Nodessupporting

confidence: 57%

“…Thus, the extended gastrectomy remains a prevalent procedure for EGJ cancer in Asia, irrespective of gastric involvement ( 14 ). The predominant tumor location, stage, and size were considered as the important indications for extended gastrectomy ( 37 , 38 ). However, a multicenter study ( 19 ) reviewing 1,289 patients with the EGJ tumors indicated that the no.…”

Section: Discussionmentioning

confidence: 99%

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Mapping of lymph node dissection determined by the epicenter location and tumor extension for esophagogastric junction carcinoma

Liang

Bi²,

Fan³

et al. 2022

Front. Oncol.

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BackgroundsPrevious studies identified the extent of lymph node dissection for esophagogastric junction (EGJ) carcinoma based on the metastatic incidence. The study aimed to determine the optimal extent and priority of lymphadenectomy based on the therapeutic efficacy from each station.MethodsThe studies on the lymph node metastasis (LNM) and therapeutic efficacy index (EI) for EGJ carcinomas were identified until April 2022. The obligatory stations with the LNM rates over 5% and therapeutic EI exceeding 2% should be routinely resected for D2 dissection, whereas the optional stations with EI between 0.5% and 2% should be resected for D3 dissection in selective cases.ResultsThe survey yielded 16 eligible articles including 6,350 patients with EGJ carcinoma. The metastatic rates exceeded 5% at no. 1, 2, 3, 7, 9, 11p, and 110 stations and were less than 5% in abdominal no. 4sa~6, 8a, 10, 11d, 12a, and 16a2/b1 and mediastinal no. 105~112 stations. Consequently, obligatory stations with EI over 2% were largely determined by the epicenter location and located at the upper perigastric, lower mediastinal, and suprapancreatic zones, corresponding to those with rates of LNM over 5%. Consistent with the LNM rates less than 5%, the optional stations with EI between 0.5% and 2% were largely dependent on the degree of tumor extension toward the lower perigastric, splenic hilar (grecurvature), para-aortic (less curvature of the cardia), and middle or upper mediastinal zones.ConclusionsThe obligatory stations can be resected as an “envelope-like” wrap by transhiatal proximal gastrectomy with lower esophagectomy, whereas the optional stations for dissection are indicated by the tumor extension. The extended gastrectomy is required for the lower perigastric in the stomach-predominant tumor with gastric involvement exceeding 5.0 cm, para-aortic dissection in the less curvature-predominant tumor and splenic hilar dissection in the grecurvature-predominant tumor whereas transthoracic subtotal esophagectomy is required for complete mediastinal dissection and adequate negative margin in the esophagus-predominant tumor with esophageal invasion exceeding 3.0 cm.

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Section: Optional Dissection Of Distal Perigastric Lymph Nodessupporting

confidence: 57%

Section: Discussionmentioning

confidence: 99%

Mapping of lymph node dissection determined by the epicenter location and tumor extension for esophagogastric junction carcinoma

Liang

Bi²,

Fan³

et al. 2022

Front. Oncol.

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“…EGJC with both pathological T3 and tumor diameter >5 cm or with T4 had metastasis in distal LNs 43 . A Chinese study showed that dissection of pyloric LNs (Nos 5 and 6) was beneficial in Siewert type II EGJC with tumor diameter >4 cm, and concluded that pyloric LN dissection is appropriate in such tumors 44 . These studies indicated that total gastrectomy should be considered for large EGJC.…”

Section: Surgical Treatmentmentioning

confidence: 99%

Essential updates 2021/2022: Perioperative and surgical treatments for gastric and esophagogastric junction cancer

Yanagimoto

Kurokawa

Doki

2023

Annals of Gastroent Surgery

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In recent years, important clinical trials for gastric cancer (GC) and esophagogastric junction cancer (EGJC) have been reported, changing the strategies of surgical and perioperative treatment. Although laparoscopic gastrectomy has already been shown to be effective for early‐stage cancer, recent evidence from both Asia (JLSSG0901, CLASS‐01 and KLASS‐02) and Europe (LOGICA and STOMACH trials) has demonstrated that it is useful for advanced GC. Robotic surgery has been rapidly gaining popularity in recent years, and randomized controlled trials are ongoing to evaluate its efficacy. A prospective nationwide multicenter study mapped sites with frequent metastasis and revealed lymphatic flow specific to EGJC, thus establishing the optimal lymph node dissection area and surgical approach based on esophageal involvement. Perioperative chemotherapy, the mainstay of treatment in Europe, also has been established in Asia by the PRODIGY and RESOLVE studies. New clinical trials have been conducted to evaluate the efficacy of combining immunotherapy or molecular‐targeted therapy with perioperative chemotherapy or chemoradiotherapy. In this review, we present important recent clinical trials regarding the treatment of GC and EGJC published in 2021 or 2022.

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“…The diagnosis and treatment of Siewert type I (5-1cm above the EGJ) and type III (2-5cm below the EGJ) have reached a worldwide consensus, while Siewert type II (1cm above to 2cm below the EGJ) has always attracted attention and controversy ( 3 , 4 ). For resected Siewert type II AEG, resection of the primary tumor and regional lymph nodes remains the cornerstone of standard treatment ( 5 ).…”

Section: Introductionmentioning

confidence: 99%

Impact of examined lymph node number on accurate nodal staging and long-term survival of resected Siewert type II-III adenocarcinoma of the esophagogastric junction: A large population-based study

et al. 2022

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BackgroundWe aimed to investigate the association between the number of examined lymph nodes (ELNs) and accurate nodal staging and long-term survival in Siewert type II-III Adenocarcinoma of the Esophagogastric Junction (AEG) by using large population-based databases and determined the optimal ELN number threshold.MethodsData on Stage I-III Siewert type II-III AEG patients from 2010 to 2014 respectively from the United States (US) SEER database and a Chinese large medical center institutional registry were analyzed for correlation between the ELN number and stage migration (node negative-to-positive) and overall survival (OS) by using multivariable-adjusted logistic and Cox regression models, respectively. The series of odds ratios (ORs), and hazard ratios (HRs) were fitted with a LOWESS smoother, and the structural breakpoints were determined by Chow test. The selected optimal cut point was then validated with the 2015 to 2016 SEER database.ResultsBoth the US cohort(n=1387) and China cohort(n=981) showed significantly increases from node-negative to node-positive disease (ORtheUS1.032,95%CI 1.017–1.046;ORChina1.034,95%CI 1.002–1.065) and enhancements in overall survival (HRtheUS0.970,95%CI 0.961-0.979;HRChina0.960,95%CI 0.940-0.980) with the increasing ELN number after controlling for confounders. Associations for both stage migration and overall survival were still significant in most subgroups’ stratification. Cut point analysis showed a threshold ELN number of 18, which was validated both in the cohorts where it originated and in an independent SEER data cohort(n=379).ConclusionsMore ELNs are associated with accurate nodal staging(negative-to-positive) as well as higher overall survival in resected Siewert types II-III AEG, We recommend 18 ELNs as the optimal cut point for the quality assessment of postoperative lymph node examination or prognostic stratification in clinical practice.

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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

Cited by 5 publications

References 28 publications

Mapping of lymph node dissection determined by the epicenter location and tumor extension for esophagogastric junction carcinoma

Mapping of lymph node dissection determined by the epicenter location and tumor extension for esophagogastric junction carcinoma

Essential updates 2021/2022: Perioperative and surgical treatments for gastric and esophagogastric junction cancer

Impact of examined lymph node number on accurate nodal staging and long-term survival of resected Siewert type II-III adenocarcinoma of the esophagogastric junction: A large population-based study

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