Lesser curvature lymph node metastases with esophageal squamous cell carcinoma: Implications for gastroplasty

Abstract

The creation of a gastric tube after subtotal esophagectomy includes resection of the lesser curvature and abdominal lymph nodes. The fundus rotation gastroplasty has been recently proposed as an alternative technique of reconstruction that preserves the vascular arcade of the lesser curvature. This study investigates the number of resected and metastatic lymph nodes associated with abdominal lymphadenectomy to assess the oncologic radicality of fundus rotation gastroplasty. In this prospective clinical trial a two-field lymphadenectomy was performed in 39 patients with squamous cell carcinoma of the esophagus. The abdominal lymphadenectomy included partial resection of compartment I (lymph node groups 1, 2, and 3) and compartment II (lymph node groups 7, 8, 9, and 11). A meticulous workup of the specimen allowed an exact classification of specific lymph node groups and their metastatic status. After two-field lymphadenectomy a total of 1170 lymph nodes (average 30.0) including 690 abdominal lymph nodes with an average of 17.7 per patient were resected. Metastatic disease was found in 27 of 39 patients (pN1 69.2%), with metastatic growth in 116 of 867 resected lymph nodes (13.4%). Of the 27 pN1 patients, 21 had abdominal lymph node metastases. Metastatic lymph nodes at the lesser curvature (groups 1, 3, and 7) were detected in 11.7%, 16.7%, and 29.7% of the resected lymph nodes, respectively. Of the 21 patients (85.7%) with abdominal lymph node metastases, 18 had positive lymph nodes at the lesser curvature. Squamous cell carcinoma of the esophagus is associated with a high rate of lymph node metastases at the lesser curvature and the left gastric artery. Therefore preservation of the lesser curvature and the left gastric artery for gastroplasty reduces the radicality regarding lymph node metastases.

Wie sicher ist die hoch intrathorakale Ösophagogastrostomie?

“…[3,4,11,13,16,19,28,36,37]. Die epidemiologischen Daten und histologischen Zuordnungen sind aus Tabelle 1 zu entnehmen.…”

“…Die postoperative Mortalität ist bei diesem Verfahren günstig [39]. Potenzielle Lymphknotenmetastasen an der kleinen Magenkurvatur und Station 7 verbleiben jedoch während der Intervallphase und könnten bezüglich der onkologischen Radikalität bei primär inkompletter Lymphadenektomie nachteilige Auswirkungen haben [3,11,28,36]. Funktionelle Ergebnisse zur Frage der Anastomosenstenose und Schluckfunktion liegen nach zweizeitigem Vorgehen mit Rekonstruktion im vorderen Mediastinum nicht vor.…”

Postoperative recovery of microcirculation after gastric tube formation

“…Fundus rotation gastroplasty does not require dissection of the left gastric artery and results in an increased tissue perfusion of the gastric fundus, compared to the standard gastric tube [4,17]. The disadvantage of this procedure is an incomplete lymphadenectomy along the lesser curvature and the left gastric artery, which are known to be the major sites of abdominal [18,19]. Another surgical technique is the formation of additional microvascular anastomoses to the upper part of the gastric conduit, which increases the arterial and venous flow along the arcade of the greater curvature [20].…”

Measurement of Microcirculation of the Gastric Conduit

“…Fundus rotation gastroplasty does not require dissection of the left gastric artery and results in an increased tissue perfusion of the gastric fundus compared to the standard gastric tube [14] . Disadvantage of this procedure is an incomplete lympadenectomy along the lesser curvature and the left gastric artery which are known to be the major sites of abdominal metastases in squamous cell and adenocarcinoma of the esophagus [16,17] . Another surgical technique is the formation of additional microvascular anastomosis to the upper part of the gastric conduit which increases the arterial and venous flow along the arcade of the greater curvature [11] .…”