Distribution of lymph node metastases in locally advanced adenocarcinomas of the esophagogastric junction (cT2-4): comparison between Siewert type I and selected Siewert type II tumors

2020 ◽  
Vol 405 (4) ◽  
pp. 509-519
Author(s):  
Akio Sakaki ◽  
Jun Kanamori ◽  
Koshiro Ishiyama ◽  
Daisuke Kurita ◽  
Junya Oguma ◽  
...  
Keyword(s):  
Lymph Node ◽  
Lymph Node Metastases ◽  
Esophagogastric Junction ◽  
Locally Advanced ◽  
Type I ◽  
Type Ii ◽  
Siewert Type ◽  
Siewert Type Ii ◽  
Node Metastases

scholarly journals Proximal Gastrectomy versus Total Gastrectomy for Siewert Type II Adenocarcinoma of the Esophagogastric Junction: A Comprehensive Analysis of Data from the SEER Registry

2019 ◽  
Vol 2019 ◽  
pp. 1-11 ◽  
Author(s):  
Kaixuan Zhu ◽  
Yingying Xu ◽  
Jiaxin Fu ◽  
Farah Abdidahir Mohamud ◽  
Zongkui Duan ◽  
...  
Keyword(s):  
Total Gastrectomy ◽  
Surgical Approach ◽  
Esophagogastric Junction ◽  
Proximal Gastrectomy ◽  
Locally Advanced ◽  
Cox Proportional Hazards Model ◽  
Type Ii ◽  
Siewert Type ◽  
Siewert Type Ii ◽  
Significant Difference

Background. To determine the ideal surgical approach (total gastrectomy (TG) vs. proximal gastrectomy (PG)) for Siewert type II adenocarcinoma of the esophagogastric junction (AEG), we searched and analyzed the Surveillance, Epidemiology, and End Results (SEER) data. Methods. Patients with Siewert type II AEG treated by TG or PG were identified from the 2004–2014 SEER dataset. We obtained the patients’ overall survival (OS) and cancer-specific survival (CSS) and stratified the patients by surgical approach. We performed a propensity score 1 : 1 matching (PSM) analysis and a univariate and multivariate Cox proportional hazards model. Results. A total of 2,217 patients with 6th AJCC stage IA–IIIB Siewert type II AEG was examined: 1,584 patients (71.4%) underwent PG, and 633 patients (28.6%) underwent TG. The follow-up time was 1–131 months. OS favored total gastrectomy before the PSM analysis (χ2=3.952, p=0.047), but after this analysis, there was no significant difference between TG and PG (χ2=2.227, p=0.136). The univariate and multivariate analyses identified age as an independent factor, and an X-tail analysis revealed 70 years as a cut-off point. The patients aged≥70 years obtained a significant long-term OS benefit from PG compared to TG (χ2=8.245, p=0.004), and those aged<70 years showed no difference between TG and PG (χ2=0.167, p=0.682). Conclusions. PG showed an equivalent survival benefit to TG in both the early and locally advanced stages of Siewert type II AEG. For elderly patients, PG is strongly recommended because of its clearer OS benefit compared to TG.

scholarly journals Novel abdominal approach for dissection of advanced type II/III adenocarcinoma of the esophagogastric junction: a new surgical option

2018 ◽  
Vol 47 (1) ◽  
pp. 398-410 ◽  
Author(s):  
Can Hu ◽  
Hao-te Zhu ◽  
Zhi-yuan Xu ◽  
Jian-fa Yu ◽  
Yi-an Du ◽  
...  
Keyword(s):  
Lymph Node ◽  
Survival Rate ◽  
Postoperative Complications ◽  
Total Gastrectomy ◽  
Surgical Approach ◽  
Esophagogastric Junction ◽  
Abdominal Cavity ◽  
Type Ii ◽  
Siewert Type ◽  
Siewert Type Ii

Objective The optimal surgical approach for Siewert type II adenocarcinoma of the esophagogastric junction (AEG) is controversial. In this study, we evaluated the outcomes of total gastrectomy for Siewert type II/III AEG via the left thoracic surgical approach that is used at our center. Methods We identified 41 patients with advanced AEG in our retrospective database and analyzed their 3-year survival rate, upper surgical margin, postoperative complications, and index of estimated benefit from lymph node dissection. Results The 3-year overall survival rate of the whole group was 63%, but no difference was observed between Siewert type II and III AEGs. Esophageal exposure and lymphadenectomy were sufficient. Eight patients developed postoperative complications, but none of the patients developed anastomotic leakage. Dissection of lymph node station Nos. 19 and 110 may be necessary for patients with Siewert type II AEG. Multivariate analysis revealed that the cT category was the only independent risk factor. Conclusions Total gastrectomy via an approach from the abdominal cavity into the thoracic cavity may be an optimal surgical technique for advanced Siewert type II AEG.

Priority of Lymph Node Dissection for Siewert Type II/III Adenocarcinoma of the Esophagogastric Junction

2013 ◽  
Vol 20 (13) ◽  
pp. 4252-4259 ◽  
Author(s):  
Shinichi Hasegawa ◽  
Takaki Yoshikawa ◽  
Yasushi Rino ◽  
Takashi Oshima ◽  
Toru Aoyama ◽  
...  
Keyword(s):  
Lymph Node ◽  
Lymph Node Dissection ◽  
Esophagogastric Junction ◽  
Type Ii ◽  
Node Dissection ◽  
Siewert Type ◽  
Siewert Type Ii

scholarly journals Lymph node ratio is an independent prognostic factor for patients with Siewert type II adenocarcinoma of esophagogastric junction: results from a 10-year follow-up study

2020 ◽  
Author(s):  
Yuling Zhang ◽  
Ditian Liu ◽  
Chunfa Chen ◽  
De Zeng
Keyword(s):  
Regression Analysis ◽  
Lymph Node ◽  
Esophagogastric Junction ◽  
Lymph Node Ratio ◽  
Cox Regression ◽  
Type Ii ◽  
Siewert Type ◽  
Cox Regression Analysis ◽  
Siewert Type Ii ◽  
Node Ratio

Abstract Background Emerging evidences suggest that lymph node ratio (LNR), the number of metastatic lymph node (LN) to the total number of dissected lymph nodes (NDLN), may predict survival in multiple types of solid tumor. However, the prognostic role of LNR in adenocarcinoma of the esophagogastric junction (AEG) remains uninvestigated. The study is intended to determine the prognostic value of LNR in the patients with Siewert type II AEG. Methods A total of 342 patients with Siewert type II AEG who underwent R0 resection were enrolled in this study. The optimal cut-off of LNR was stratified into tertiles using X-tile software. The log-rank test was used to evaluate the survival differences, and multivariate Cox regression analysis were performed to determine the independent prognostic variables. Results The optimal cut-off of LNR were classified as LNR = 0, LNR between 0.01 and 0.40 and LNR > 0.41. Patients with high LNR had a shorter 5- and 10-year disease-specific survival (DSS) rate (8.5%, 1.4%) compared with those with moderate LNR (20.4%, 4.9%) and low LNR (58.0%, 27.5%) ( P < 0.001). Multivariate Cox regression analysis indicated that LNR was an independent factor for DSS after adjusting for confounding variables ( P < 0.05). Furthermore, after stratification by NDLN between NDLN < 15 group and NDLN ≥ 15 group, the LNR remained a significant predictor for DSS ( P < 0.05). Conclusions LNR is an independent predictor for DSS in patients with Siewert type II AEG regardless of NDLN. Patients with higher LNR have significantly shorter DSS.

scholarly journals Survival Benefit of Pyloric Lymph Node Dissection for Siewert Type II/III Adenocarcinoma of the Esophagogastric Junction Based on Tumor Diameter: A Large Cohort Study

2021 ◽  
Vol 11 ◽  
Author(s):  
Xia Lin ◽  
Zhengyan Li ◽  
Chenjun Tan ◽  
Xiaoshuang Ye ◽  
Jie Xiong ◽  
...  
Keyword(s):  
Lymph Node ◽  
Lymph Nodes ◽  
Esophagogastric Junction ◽  
Tumor Diameter ◽  
Type Ii ◽  
Node Dissection ◽  
Siewert Type ◽  
Siewert Type Ii ◽  
Type Iii ◽  
Siewert Type Iii

BackgroundIt is unclear whether the dissection of pyloric lymph nodes (PLNs, No. 5 and No. 6 lymph nodes) is necessary for adenocarcinoma of the esophagogastric junction (AEG) with a tumor diameter &gt;4 cm based on current guidelines. This study aimed at evaluating whether pyloric node lymphadenectomy is essential for patients with Siewert type II/III AEG according to different tumor diameters.MethodsThis study included 300 patients on whom transabdominal total gastrectomy was performed for Siewert type II/III AEG at a high-volume center in China from January 2006 to December 2015. The index of estimated benefit from lymph node dissection (IEBLD) was used to analyze the priority of pyloric lymphadenectomy.ResultsIn Siewert type II AEG, the 5-year overall survival (OS) and the 5-year disease-free survival (DFS) were similar between patients with PLN-positive cancer and patients of stage III AEG without PLN metastasis (23.1% vs. 30.6%, p = 0.505; 23.1% vs. 27.1%, p = 0.678). However, in Siewert type III AEG, the OS and the DFS of patients with PLN-positive cancer were significantly lower than that of patients with stage III without PLN metastasis (7.9% vs. 27.8%, p = 0.021; 0 vs. 26.8%, p = 0.005). According to the IEBLD, the dissection of PLNs did not appear to be beneficial in either Siewert type II AEG or type III AEG, whereas a stratified analysis revealed that PLN dissection yielded a high therapeutic benefit for Siewert type II AEG with tumor diameters &gt;4 cm.ConclusionWe recommended that the PLNs be dissected in Siewert type II AEG when a tumor diameter is &gt;4 cm. Total gastrectomy should be optional for Siewert type II AEG with a tumor diameter &gt;4 cm and Siewert type III AEG.

scholarly journals Short-Term Clinical Efficacy of Neoadjuvant Chemotherapy Combined With Laparoscopic Gastrectomy for Locally Advanced Siewert Type II and III Adenocarcinoma of the Esophagogastric Junction: A Retrospective, Propensity Score-Matched Study

2021 ◽  
Vol 11 ◽  
Author(s):  
Qing Feng ◽  
Du Long ◽  
Ming-shan Du ◽  
Xiao-song Wang ◽  
Zhen-shun Li ◽  
...  
Keyword(s):  
Risk Factor ◽  
Neoadjuvant Chemotherapy ◽  
Propensity Score ◽  
Esophagogastric Junction ◽  
Independent Risk Factor ◽  
Locally Advanced ◽  
Type Ii ◽  
Short Term ◽  
Siewert Type ◽  
Siewert Type Ii

BackgroundLaparoscopic gastrectomy (LG) has been increasingly used for the treatment of locally advanced Siewert type II and III adenocarcinoma of the esophagogastric junction (AEG). However, whether LG can achieve the same short-term efficacy in the treatment of patients who receive neoadjuvant chemotherapy (NACT) remains controversial. Thus, the aim of this study was to investigate the clinical outcomes of NACT combined with LG for Siewert type II and III AEG.MethodsThis retrospective study identified patients with locally advanced Siewert type II and III AEG diagnosed between May 2011 and October 2020 using the clinical tumor-node-metastasis (cTNM) staging system. The short-term outcomes were compared between the matched groups using a 1:3 propensity score matching (PSM) method, which was performed to reduce bias in patient selection.ResultsAfter PSM, 164 patients were selected, including 41 in the NACT group and 123 in the LG group. The baseline characteristics were similar between the two groups. Compared with the LG group, the NACT group exhibit a smaller tumor size and significantly less advanced pathological tumor classification and nodal classification stages. The time to first flatus of the NACT group was significantly shorter, but the hospital stay was significantly longer than that of the LG group. The NACT group showed similar overall (29.3% vs 25.2%, P=0.683), systemic (24.4% vs 21.1%, P=0.663), local (12.2% vs 9.8%, P=0.767), minor (19.5% vs 19.5%, P=1.000) and major (9.8% vs 5.7%, P=0.470) complications as the LG group. Subgroup analyses showed no significant differences in most stratified parameters. Operation time≥ 300 minutes was identified as an independent risk factor for overall complications. Age≥ 60 years was identified as an independent risk factor for major complications.ConclusionNACT combined with LG for AEG does not increase the risk of postoperative morbidity and mortality compared with LG.

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