Treatment Approaches to Esophagogastric Junction Tumors

Kurokawa, Yukinori; Sasako, Mitsuru; Doki, Yuichiro

doi:10.1159/000350880

Cited by 19 publications

(13 citation statements)

References 29 publications

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“…While the three Siewert types are almost equally distributed in Western countries, in the Eastern ones a much lower proportion of type I respect to the others [14].…”

Section: Classification and Staging Of Gejmentioning

confidence: 86%

Radiochemotherapy in the Management of Gastroesophageal Junction Tumours: Basic Evidences in the Neoadjuvant Setting

Cellini¹,

Fiore²,

Mattiucci³

2013

J Gastrointest Dig Syst

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In recent years the incidence of gastroesophageal junction (GEJ) tumors has been rapidly increasing. Many trials have investigated the role of preoperative radiochemotherapy for this specific subgroup. In past, GEJ tumors were sometimes considered either esophageal or gastric cancer, due to their anatomical location. Purpose of this paper is to elucidate the benefit of radiotherapy in combination with concurrent chemotherapy in neoadjuvant setting, reviewing the literature by the point of view of the recent classification provided for GEJ tumors.

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“…While the three Siewert types are almost equally distributed in Western countries, in the Eastern ones a much lower proportion of type I respect to the others [14].…”

Section: Classification and Staging Of Gejmentioning

confidence: 86%

Radiochemotherapy in the Management of Gastroesophageal Junction Tumours: Basic Evidences in the Neoadjuvant Setting

Cellini¹,

Fiore²,

Mattiucci³

2013

J Gastrointest Dig Syst

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“…As compared to type I tumors, where lymph node involvement in the mediastinum reached 50%, type II tumors, mediastinal nodes were involved in only 11% of patients in one large series [15]. Further characteristics of these tumors based on Siewert classification are summarized in Table 1 [10,18].…”

Section: Siewert Type II Adenocarcinomamentioning

confidence: 99%

Surgical approaches to adenocarcinoma of the gastroesophageal junction: the Siewert II conundrum

Brown

Giugliano

Berger

et al. 2017

Langenbecks Arch Surg

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Careful review of the data appear to support the fact that a satisfactory oncologic resection can be achieved via a transabdominal extended total gastrectomy with a slight advantage in terms of perioperative complications, and overall postoperative quality of life. Overall and disease-free survival compares favorably to the transthoracic approach. These results can be achieved with careful selection of patients balancing more than just the Siewert type in the decision-making but considering also preoperative T and N stages, histological type (diffuse type requiring longer margins that are not always achievable via gastrectomy), and the presence of Barrett's esophagus.

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“…[4,5] For the Siewert types I and III AEJ, the surgical strategies are well elucidated. [6–8] But the optimal surgical approach and extent of lymph nodes dissection remain controversial in Siewert type II AEJ.…”

Section: Introductionmentioning

confidence: 99%

New evidence guiding extent of lymphadenectomy for esophagogastric junction tumor

Zheng

Ni²,

Chen³

et al. 2017

Medicine

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For Siewert type II adenocarcinoma of the esophagogastric junction (AEJ), the optimal surgical approach and extent of lymph nodes dissection remain controversial. Immunohistochemistry (IHC) has been reported to be available for identifying lymph node micrometastasis (LNMM) in patients with AEJ. This was a prospective case series of patients who underwent R0 resection and lower mediastinal lymphadenectomy from January 2010 to June 2015 in Fujian Medical University Union Hospital for Siewert type II AEJ. The outcomes were analyzed retrospectively. A total of 1325 lymph nodes were collected from 49 patients, grouped into 3 groups: lower mediastinal, paracardial, and abdominal. The former 2 groups were examined by monoclonal antibodies against Ber-Ep4 and CD44v6. The incidence of LNMM in mediastinal group was 37% (18/49) for Ber-Ep4 and 33% (16/49) for CD44v6. While in routine histological diagnosis, the number of patients with the positive lymph nodes was 7 (14%). When combining IHC with histopathology (HE) staining, the incidence of positive mediastinal lymph nodes was increased to 24%, with a total number of 37 lymph nodes from 28 patients (57%). Micrometastases indicated by Ber-Ep4 and CD44v6 were associated with the depth of tumor invasion (P = 0.020 and 0.037, respectively), histopathological nodal status (P = 0.024 and 0.01, respectively), and Lauren classification (P = 0.038 and, respectively). Expression of CD44v6 and Ber-Ep4 was positively correlated (r = 0.643, P < 0.001). The 3- and 5-year survival rates for all patients were 66% and 50%, respectively. The patients with LNMM had a lower 3-year survival rate of 51%, compared to 80% from no LNMM group; 5-year survival rate was also lower in LNMM group, which is 29% versus 68% (P = 0.006) in the no LNMM group. Patients with positive Ber-Ep4 cells had a lower survival, but not statistically significant (P = 0.058). CD44v6-positive group had a significantly reduced survival (P < 0.001). In patients group with negative lower mediastinal lymph nodes, patients without LNMM obtained a significant survival benefit (P = 0.021). Our study demonstrated that routine test for LNMM is necessary for patients with negative lymph nodes. As a positive prognostic factor, thorough lower mediastinal lymphadenectomy in an invasive approach should be considered when necessary. Ber-Ep4 and CD44v6 were shown to be great markers for detecting LNMM.

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Treatment Approaches to Esophagogastric Junction Tumors

Cited by 19 publications

References 29 publications

Radiochemotherapy in the Management of Gastroesophageal Junction Tumours: Basic Evidences in the Neoadjuvant Setting

Radiochemotherapy in the Management of Gastroesophageal Junction Tumours: Basic Evidences in the Neoadjuvant Setting

Surgical approaches to adenocarcinoma of the gastroesophageal junction: the Siewert II conundrum

New evidence guiding extent of lymphadenectomy for esophagogastric junction tumor

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