Optimal Extent of Lymph Node Dissection for Siewert Type II Esophagogastric Junction Carcinoma

Abstract

Clear anatomic distinction of EGJ tumors is likely to provide insight into the appropriate extent of lymphadenectomy. Dissection of the paracardial and lesser curve nodes is essential for staging as well as for obtaining therapeutic benefit in surgery for in EGJ carcinomas (Siewert type II).

Pattern of abdominal nodal spread and optimal abdominal lymphadenectomy for advanced Siewert type II adenocarcinoma of the cardia: results of a multicenter study

“…1, in which metastatic nodal spread was seen in 80 % of patients with a striking contrast in the frequency between the perigastric nodes of the upper half of the stomach in positions 1-3 and those of the lower half of the stomach in positions 4d-6. With regard to the second-tier stations, lymph nodes along the left gastric artery (station 7) were affected in a substantial percentage of patients (18-65 %) with type II tumors in previous reports [5,[17][18][19][20][21][22], which was compatible with our findings shown in Fig. 1.…”

“…1. A low percentage of metastases to the second-tier nodes at the splenic hilum was observed in this study (2.9 %), which is also in accordance with previous reports (3.9-5.0 %) [18][19][20]. A precise understanding of how type II adenocarcinoma spreads to abdominal lymph nodes helps guide the surgeon when choosing the appropriate type of resection and lymphadenectomy.…”

“…Lymph node stations are classified according to Japanese criteria 17 In this study, long-term survival was mostly limited to the patients with fewer than 7 metastatic nodes, and the independent prognostic value of nodal involvement was demonstrated in the multivariate analysis. Similar to these results, the involvement of second-tier lymph nodes [6,10,23] and the presence of more than 6 metastatic nodes [18,19,21] have already been reported as negative prognostic factors in GEJ adenocarcinoma. Although age less than 65 years was identified as a significant positive prognostic factor, the depth of invasion (pT) was not an independent determinant of survival, as shown in Table 2, which is supported by other report [19].…”

“…There have been several reports regarding the pattern of abdominal lymph node spread of Siewert type II adenocarcinoma [17][18][19][20]. Italian investigators reported that 44 of 62 patients (71 %) with pT2-4 Siewert type II tumors had lymph node metastases, and a high frequency of nodal involvement in the perigastric nodes of the upper half of the stomach (right paracardial 50 %, left paracardial 32 %, lesser curvature 53 %) was seen, in contrast to the fairly low percentage of metastases in the lymph nodes along the right gastroepiploic artery (7 %), suprapyloric (2 %), and infrapyloric lymph nodes (2 %) [17,18].…”

Should we remove splenic hilus lymph nodes for esophagogastric junction adenocarcinoma?

“…Yamashita et al [17] evaluated 225 patients with Siewert type II tumors retrospectively. They found that the incidence of nodal metastasis was highest in the right paracardial (38.2 %), the lesser curvature (35.1 %), the left paracardial (23.1 %), and the nodes along the left gastric artery (20.9 %).…”