Abstract
Background
There is no consensus regarding the optimal extent of lymphadenectomy for the esophagogastric junctional (EGJ) cancer. The Japanese esophagogastric cancer treatment guideline showed the tentative standard in the extent of lymphadenectomy based on the location, histology and T-categories. The purpose of this study is to identify the lymph node status in patients with pT1 EGJ adenocarcinoma.
Methods
From January 2000 to November 2016, we underwent radical resection with or without sentinel lymph node (SN) mapping for esophagogastric cancer at Keio University Hospital. We identified 38 patients with pT1 adenocarcinoma with its center located within 2cm of the junction. We then analyzed the lymph node status and SN distribution.
Results
The primary tumor that had their epicenter within the proximal of the cardia in 37%, that had their epicenter within the distal of the cardia in 63% of all patients (n = 12, 26). The surgical procedures were proximal gastrectomy (n = 30); subtotal esophagectomy (n = 4); and total gastrectomy(n = 4). Two patients (5%) had positive lymph node metastasis. Of the 2 patients with positive node, one patient had the metastatic lymph node along the short gastric vessels and the other patient had the metastatic lymph nodes along both the left gastric artery and the celiac artery. Those 2 patients with positive node had no recurrence. However, liver or local (anastomotic) recurrence occurred in 1 patients, respectively. SN was accomplished in all patients who underwent SN mapping and diagnostic accuracy based on the SN status was 100% (17/17).
Conclusion
Our results suggested that lower mediastinal lymphadenectomy was of limited significance in patients with pT1 EGJ adenocarcinoma. SN mapping may be contributory to the optimal extent of lymphadenectomy.
Disclosure
All authors have declared no conflicts of interest.
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