The optimal extent of lymph node dissection for adenocarcinoma of the esophagogastric junction differs between Siewert type II and Siewert type III patients

Goto, Hironobu; Tokunaga, Masanori; Miki, Yuichiro; Makuuchi, Rie; Sugisawa, Norihiko; Tanizawa, Yutaka; Bando, Etsuro; Kawamura, Taiichi; Niihara, Masahiro; Tsubosa, Yasuhiro; Terashima, Masanori

doi:10.1007/s10120-014-0364-0

Cited by 57 publications

(63 citation statements)

References 25 publications

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“…Because it is impossible to determine a cut-off level as a definite indication for LN dissection (13), the IEBLD of mesenteric LNs, which are routinely dissected in locally advanced rectal cancer, was used as reference. Previous articles dealing with IEBLD also used the IEBLD of routinely dissected LNs as a reference (14)(15)(16)(17)(18).…”

Section: Methodsmentioning

confidence: 99%

Index of Estimated Benefit from Lateral Lymph Node Dissection for Middle and Lower Rectal Cancer

Numata

Yamaguchi

Kinugasa

et al. 2017

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Section: Methodsmentioning

confidence: 99%

Index of Estimated Benefit from Lateral Lymph Node Dissection for Middle and Lower Rectal Cancer

Numata

Yamaguchi

Kinugasa

et al. 2017

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“…Especially at lymph node stations 1 and 3, the incidence is high in both types of tumors (up to 52.5%). 50 The incidence of metastasis in the lower perigastric nodes (stations 4d -6) seems to be especially low in type II EGJ cancers. 51 Incidence of lymph node metastasis is less than 10% at the coeliac axis, around the splenic artery, splenic hilum, and lower mediastinum in type II cancers.…”

Section: More or Less Extensive Lymphadenectomy?mentioning

confidence: 96%

The surgical management of esophago-gastric junctional cancer

Kauppila

Lagergren

2016

Surgical Oncology

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The best available surgical strategy in the treatment of resectable esophago-gastric junctional (EGJ) cancer is a controversial topic. In this review we evaluate the current literature and scientific evidence examining the surgical treatment of locally advanced EGJ cancer by comparing esophagectomy with gastrectomy, transhiatal with transthoracic esophagectomy, minimally invasive with open esophagectomy, and less extensive with more extensive lymphadenectomy. We also assess endoscopic procedures increasingly used for early EGJ cancer. The current evidence does not favor any of the techniques over the others in terms of oncological outcomes. Health-related quality of life may be better following gastrectomy compared to esophagectomy. Minimally invasive procedures might be less prone to surgical complications. Endoscopic techniques are safe and effective alternatives for early-stage EGJ cancer in the short term, but surgical treatment is the mainstay in fit patients due to the risk of lymph node metastasis. Any benefit of lymphadenectomy extending beyond local or regional nodes is uncertain. This review demonstrates the great need for well-designed clinical studies to improve the knowledge in how to optimize and standardize the surgical treatment of EGJ cancer.

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“…The extent of gastrectomy and lymphadenectomy for Siewert II AEG remains controversial [25][26][27]. To some extent, it has caused a difference in the distribution of the number of retrieved LNs at different institutions.…”

Section: Discussionmentioning

confidence: 99%

Prognostic performance of different lymph node staging systems after curative resection for Siewert type II adenocarcinoma of the esophagogastric junction

Zhang

2020

Preprint

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Background: The tumor-node-metastasis (TNM) pN stage, which is based on the number of positive lymph nodes (LNs), is an important prognostic factor for patients with adenocarcinoma of the esophagogastric junction (AEG). The lymph node ratio (LNR) and log odds of metastatic lymph nodes (LODDS) staging systems are new effective indicators of prognosis. We aimed to evaluate their prognostic value in Siewert type II AEG.Methods: Patients diagnosed with Siewert type II AEG who underwent curative resection between 2004 and 2014 at Guangdong General Hospital were recruited. A Cox regression model was constructed, and prognostic performance was measured using Harrell’s concordance index (C-index) and the Akaike information criterion (AIC).Results: When LN status was modeled as a continuous variable, the LODDS system (C-index: 0.729; AIC: 940.483) outperformed the other staging systems, including the number of positive LNs (LNP) (C-index: 0.721; AIC: 946.935) and LNR (C-index: 0.725; AIC: 938.918).However,when assessed as categorical variables, the LNR staging system had a better prognostic performance (C-index: 0.752; AIC: 926.350) than the American Joint Committee on Cancer (AJCC) 8th edition TNM pN (C-index: 0.740; AIC: 934.349) and LODDS (C-index: 0.737; AIC: 939.087) staging systems. Each LNR stage is more evenly distributed than the other two staging systems. Moreover, the LODDS stage is more dependent on the TLNE.Conclusion: The LNR represented the best prognostic factor when assessed as a categorical variable and may serve as an alternative nodal staging system for AEG.

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The optimal extent of lymph node dissection for adenocarcinoma of the esophagogastric junction differs between Siewert type II and Siewert type III patients

Cited by 57 publications

References 25 publications

Index of Estimated Benefit from Lateral Lymph Node Dissection for Middle and Lower Rectal Cancer

Index of Estimated Benefit from Lateral Lymph Node Dissection for Middle and Lower Rectal Cancer

The surgical management of esophago-gastric junctional cancer

Prognostic performance of different lymph node staging systems after curative resection for Siewert type II adenocarcinoma of the esophagogastric junction

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