Distribution of involved abdominal lymph nodes is correlated with the distance from the esophagogastric junction to the distal end of the tumor in Siewert type II tumors

Mine, Shinji; Kurokawa, Yukinori; Takeuchi, Hiroya; Kutsukake, Kentaro; Ito, Y.; Ohi, Masaki; Matsuda, Tatsuo; Hamakawa, Takuya; Hasegawa, Shin; Yoshikawa, Takaki; Hiki, Naoki

doi:10.1016/j.ejso.2015.05.004

Cited by 36 publications

(39 citation statements)

References 24 publications

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“…28 In addition, there have been reports regarding how far to the gastric side (or esophageal side) cancer has advanced from the EGJ line that have proposed that different assessment items should be used for esophageal cancer and gastric cancer. 29,30 Figure 3 Range over which the cardiac gland is distributed, as indicated by Hayward, 14 Sarbia et al 15 and Nakanishi et al 16 In general, this corresponds to the Siewert type II region, suggesting that this region can be considered to be the esophagogastric junction zone. The EGJ zone should be thought of as a third zone that differs from both the stomach and the esophagus not only from the anatomical and histological perspective, but also when considered clinically.…”

Section: T He Tnm Classification Of Malignant Tumours 7thmentioning

confidence: 98%

“…Also, when the site of lymph node metastasis is taken into account, the esophagus and the stomach should be staged differently . In addition, there have been reports regarding how far to the gastric side (or esophageal side) cancer has advanced from the EGJ line that have proposed that different assessment items should be used for esophageal cancer and gastric cancer …”

Section: Differences Between Cancers Occurring In the Egj Zone And Eacmentioning

confidence: 99%

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Considering the esophagogastric junction as a ‘zone’

Ichihara

Uedo

Gotoda

2017

Digestive Endoscopy

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Siewert's classification of adenocarcinoma of the esophagogastric junction (EGJ) classifies tumors anatomically for determining the appropriate surgical technique. According to this classification, a type II tumor, true carcinoma of the cardia, is defined as a cancer within 1 cm proximal to 2 cm distal of the EGJ. Histological analysis indicates that the cardiac gland is present with a high degree of frequency between 1–2 cm to the gastric side and 1–2 cm to the esophageal side of the EGJ, which means that this zone can be considered as neither the stomach nor the esophagus but rather as a third zone known as the ‘EGJ zone’. It has been suggested that there are multiple causes for development of adenocarcinoma in the EGJ zone. The TNM Classification of Malignant Tumours 7th Edition considers EGJ adenocarcinoma (EGJAC) occurring in the EGJ zone to be a part of esophageal adenocarcinoma (EAC). However, recent studies have indicated that EGJAC behaves differently from EAC and gastric carcinoma. Barrett's esophagus is now considered an important factor in the etiology of EGJAC, but, as yet, no studies have elucidated the differences between cancer arising from short‐segment Barrett's esophagus and cancer of the gastric cardia. Thus, there is currently no clinical relevance to subdivision of adenocarcinoma in the EGJ zone into above or below the EGJ line.

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Section: T He Tnm Classification Of Malignant Tumours 7thmentioning

confidence: 98%

Section: Differences Between Cancers Occurring In the Egj Zone And Eacmentioning

confidence: 99%

Considering the esophagogastric junction as a ‘zone’

Ichihara

Uedo

Gotoda

2017

Digestive Endoscopy

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“…S. Mine и соавт. отмечали более редкие случаи лимфогенного опухолевого поражения в области нижней части желудка при длине участка от ПЖП до дистального края опухоли менее 30 мм [18]. Y. Sato и соавт.…”

Section: How To Decide Surgical Procedures Fro Esophagogastric Junctiounclassified

The surgical procedure for esophagogastric junction cancer — discussing the tactics

Ischenko

Викторович²,

Pavlov

et al. 2020

Journal of Clinical Practice

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Introduction. Currently, there is no standardized surgical tactics for the esophagogastric junction cancer treatment. The issues of the resection margin, volume of lymphodissection and the optimal size of the gastric stump are still being discussed. This article analyzes the influence of these parameters on the recurrence-free survival and postoperative quality of life for patients, according to the literature data. Objective. Analysis of the treatment outcomes for patients with esophagogastric junction cancer, depending on the surgical tactics. Materials and Methods. The article analyzes the literature data evaluating various approaches in the surgical treatment of esophagogastric junction cancer. We present an example (from the Yasuyuki Seto study) of a patient with proximal gastric adenocarcinoma with a depth of T3 invasion and the surgical tactics regarding the size of the gastric stump. a A great advantage of the resection margin located at 2 cm from the proximal margin and at 5 cm from the distal margin has been shown. According to the results of our own observations, a patient with proximal gastric adenocarcinoma with an invasion depth of T3 underwent a resection with the proximal and distal resection margins of 13 and 65 mm, respectively. Negative resection margins were diagnosed intraoperatively. The patient's recurrence -free survival was 6 years. A total gastrectomy or esophagectomy are not the operations of choice because of the worsening of the patient's quality of life. When analyzing the depth of invasion according to the literature data, it has been found that an invasion in the esophagus of more than 30 mm is associated with an increased risk of metastatic lymph nodes of the superior and middle mediastinum. With a gastric invasion length of more than 40 mm, lymph nodes of lesser curvature along the right gastric artery are affected. According to the literature, a gastric stump with the size of more than two-thirds of the organ size was favorable in terms of the postoperative quality of life. Many authors indicate the positive effect of maintaining the gastroesophageal sphincter and cardia of the stomach. In the study by Yasuyuki Seto, proximal gastric resection was applied only if it was possible to maintain more than 12 cm in the small curvature and 25 cm in the large curvature. Conclusion. When choosing the surgical tactics for the esophagogastric junction cancer, one needs to focus on the patient's quality of life after the surgery. It is necessary to achieve negative resection margins in each case. The resection margins should be more than 2 and 5 cm for the proximal and distal margins, respectively. Dissection of the lymph nodes of the middle and superior mediastinum should be carried out with invasion of the tumor into the esophagus by more than 30 mm, removal of the lymph nodes of the lesser curvature of the stomach along the right gastric artery must be carried out if the tumor invasion into stomach is more than 40 mm. It is optimal to keep the gastric stump equal to two-thirds of the size of the organ. The issue of the surgical tactics in cancer of the esophageal-gastric transition is of great practical importance and requires a further study.

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“…Mine и соавт. информируют нас относительно желудочной инвазии: частота лимфогенного опу-холевого поражения вокруг нижней части желудка была невысокой, тогда как расстояние от ПЖП до дистального конца опухоли составляло менее 30 мм [29]. Y. Sato и соавт.…”

Section: важные аспекты хирургической тактики при раке пищеводно-желуunclassified

How to decide surgical procedure for esophagogastric junction cancer?

Seto

Yamashita

2020

Journal of Clinical Practice

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Standard surgical procedure for esophagogastric junction cancer, especially adenocarcinoma, has still remained controversial. Various procedures has been allowed and applied for Siewert type II tumors. Negative long resection margin had been regarded as essential in decision on the procedure. Recent papers have, however, shown the priority of invasion length to each side (esophagus and stomach), because it relates the frequency and sites of lymph node metastasis to be dissected. And, the size of remnant stomach is, also, important when a proximal gastrectomy is considered.

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Distribution of involved abdominal lymph nodes is correlated with the distance from the esophagogastric junction to the distal end of the tumor in Siewert type II tumors

Cited by 36 publications

References 24 publications

Considering the esophagogastric junction as a ‘zone’

Considering the esophagogastric junction as a ‘zone’

The surgical procedure for esophagogastric junction cancer — discussing the tactics

How to decide surgical procedure for esophagogastric junction cancer?

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