The probability of Lymph node metastasis with a tumor size larger than and smaller than 4 cm is different in stages T1-T3 of Siewert type II adenocarcinoma of esophagogastric junction: A Population-Based Study

Abstract BackgroundIncidence of adenocarcinoma of the esophagogastric junction (AEG) is increasing in Japan as well as Western Country. However, there is no consensus on treatment strategy. The purpose of this study was to determine the optimal range of resection and lymph node dissection for Siewert type II AEG and to develop a strategy for treatment that includes adjuvant therapy to improve the survival rate. MethodsWe retrospectively investigate 88 cases of advanced AEG in patients who underwent surgery with lymph node dissection with 52 cases of superficial AEG, 23 of whom underwent endoscopic treatment (endoscopic mucosal resection [EMR] or endoscopic submucosal dissection [ESD]), and 29 of whom underwent surgery with lymph node dissection. ResultsThe optimal lymph nodes to resect for advanced AEG were in the inferior mediastinum (No. 110), in the lesser curvature (Nos. 1, 3, 7), No. 2, and No 11. According to area of actual lymph node metastasis, lymphadenectomy of lymph nodes 1, 2, 3, 7, and 11 was sufficient to improve survival of patients with superficial AEG. If esophageal involvement was >40 mm, we performed esophagectomy through right thoracotomy. The 5-year overall survival rates were 88% for patients treated with ESD, 78% for those with superficial AEG who under-went surgery, and 24% for those with advanced AEG (p = 0.011). Despite of lymph node dissection, twenty-five patients experienced lymph node metastasis after operation in advanced AEG and there were many disseminations in advanced AEG. There were no differences in survival between patients who received postoperative adjuvant therapy with S-1 for advanced AEG and those who received surgery alone (p = 0.5192).Conclusion Although surgical procedures of superficial and locally advanced AEG are standardized, the role of adjuvant therapy for AEG is still controversial. We recommend nab-paclitaxel plus radiotherapy for advanced AEG as neoadjuvant therapy.

Download Full-text

The prognostic relevance of parapyloric lymph node metastasis in Siewert type II/III adenocarcinoma of the esophagogastric junction

European Journal of Surgical Oncology ◽

10.1016/j.ejso.2017.08.017 ◽

2017 ◽

Vol 43 (12) ◽

pp. 2333-2340 ◽

Cited By ~ 7

Author(s):

Jia-Bin Wang ◽

Man-Qiang Lin ◽

Ping Li ◽

Jian-Wei Xie ◽

Jian-Xian Lin ◽

...

Keyword(s):

Lymph Node ◽

Lymph Node Metastasis ◽

Esophagogastric Junction ◽

Type Ii ◽

Siewert Type ◽

Siewert Type Ii ◽

Node Metastasis ◽

Prognostic Relevance

Download Full-text

Current and Proposed Treatment Strategies for Siewert Type II Adenocarcinoma of the Esophagogastric Junction

10.21203/rs.3.rs-1109377/v2 ◽

2022 ◽

Author(s):

Kosuke Narumiya ◽

Kenji Kudo ◽

Yosuke Yagawa ◽

Shinsuke Maeda ◽

Yukinori Toyoshima ◽

...

Keyword(s):

Lymph Node ◽

Lymph Node Metastasis ◽

Adjuvant Therapy ◽

Lymph Node Dissection ◽

Esophagogastric Junction ◽

Type Ii ◽

Node Dissection ◽

Siewert Type ◽

Siewert Type Ii ◽

Node Metastasis

Abstract BackgroundIncidence of adenocarcinoma of the esophagogastric junction (AEG) is increasing in Japan as well as Western Country. However, there is no consensus on treatment strategy. The purpose of this study was to determine the optimal range of resection and lymph node dissection for Siewert type II AEG and to develop a strategy for treatment that includes adjuvant therapy to improve the survival rate. MethodsWe retrospectively investigate 88 cases of advanced AEG in patients who underwent surgery with lymph node dissection with 52 cases of superficial AEG, 23 of whom underwent endoscopic treatment (endoscopic mucosal resection [EMR] or endoscopic submucosal dissection [ESD]), and 29 of whom underwent surgery with lymph node dissection. Results The optimal lymph nodes to resect for advanced AEG were in the inferior mediastinum (No. 110), in the lesser curvature (Nos. 1, 3, 7), No. 2, and No 11. According to area of actual lymph node metastasis, lymphadenectomy of lymph nodes 1, 2, 3, 7, and 11 was sufficient to improve survival of patients with superficial AEG. If esophageal involvement was >40 mm, we performed esophagectomy through right thoracotomy. The 5-year overall survival rates were 88% for patients treated with ESD, 78% for those with superficial AEG who under-went surgery, and 24% for those with advanced AEG (p = 0.011). Despite of lymph node dissection, twenty-five patients experienced lymph node metastasis after operation in advanced AEG and there were many disseminations in advanced AEG. There were no differences in survival between patients who received postoperative adjuvant therapy with S-1 for advanced AEG and those who received surgery alone (p = 0.5192).ConclusionAlthough surgical procedures of superficial and locally advanced AEG are standardized, the role of adjuvant therapy for AEG is still controversial. We recommend nab-paclitaxel plus radiotherapy for advanced AEG as neoadjuvant therapy.

Download Full-text

FA05.04: CLINICAL SIGNIFICANCE OF ESOPHAGEAL INVASION LENGTH FOR THE PREDICTION OF MEDIASTINAL LYMPH NODE METASTASIS IN SIEWERT TYPE II ADENOCARCINOMA

Diseases of the Esophagus ◽

10.1093/dote/doy089.fa05.04 ◽

2018 ◽

Vol 31 (Supplement_1) ◽

pp. 10-11

Author(s):

Kazuo Koyanagi ◽

Fumihiko Kato ◽

Jun Kanamori ◽

Hiroyuki Daiko ◽

Yuji Tachimori ◽

...

Keyword(s):

Lymph Node ◽

Lymph Node Metastasis ◽

Mediastinal Lymph Node ◽

Esophageal Wall ◽

Type Ii ◽

Mediastinal Lymph Node Metastasis ◽

Siewert Type ◽

Siewert Type Ii ◽

Node Metastasis ◽

Esophageal Invasion

Abstract Background We focused on the esophageal invasion length (EIL), defined as the distance from the EGJ to the proximal edge, of Siewert type II adenocarcinomas. This study investigated whether the EIL could be a possible indicator of mediastinal lymph node metastasis and survival in the Siewert type II patients. Methods The 168 consecutive patients with Siewert type II tumor who underwent surgery were enrolled. Metastatic stations and recurrent lymph node sites were classified into cervical, upper/middle/lower mediastinal, and abdominal zones. EIL was correlated with overall metastasis or recurrence in individual zones and survival. Results The ROC curve for EIL was generated to predict the rates of upper and middle mediastinal lymph node metastasis or recurrence, and the cut-off EIL value was determined to be 25 mm with an area under the curve of 0.83 (sensitivity, 80.8%; specificity, 72.3%). Siewert type II patients with an EIL of more than 25 mm (> 25 mm EIL group) had a higher incidence of overall metastasis or recurrence in the upper and middle mediastinal zones than those with an EIL of less than or equal to 25 mm (≤ 25 mm EIL group) (P = 0.001 and P < 0.001). Disease free and overall survival in the > 25 mm EIL group were significantly lower than those of the ≤ 25 mm EIL group (P < 0.001). None of the Siewert type II patients with metastasis or recurrence in the upper and middle mediastinal zones survived for more than five years. On the other hand, the efficacy index of the lower mediastinal lymph node and the abdominal lymph node were 5.6 and 21.7, respectively. Only EIL of more than 25 mm was a significant preoperative predictor of overall metastasis or recurrence in the upper and middle mediastinal zone (odds ratio, 8.85; 95% CI, 2.31−33.3; P = 0.001). Conclusion An EIL of more than 25 mm might be a preoperative predictor of overall metastasis or recurrence in the upper and middle mediastinal zones. A multimodal-therapeutic strategy should be investigated in Siewert type II patients once the tumor has invaded to the esophageal wall more than 25 mm. Disclosure All authors have declared no conflicts of interest.

Download Full-text

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

Journal of Gastrointestinal Cancer ◽

10.1007/s12029-020-00468-y ◽

2020 ◽

Author(s):

Yuling Zhang ◽

Ditian Liu ◽

De Zeng ◽

Chunfa Chen

Keyword(s):

Lymph Node ◽

Esophagogastric Junction ◽

Lymph Node Ratio ◽

Type Ii ◽

Siewert Type ◽

Siewert Type Ii ◽

Follow Up Study ◽

Adenocarcinoma Of Esophagogastric Junction ◽

Node Ratio

Download Full-text

Survival nomogram for patients with metastatic siewert type II adenocarcinoma of the esophagogastric junction: a population-based study

Expert Review of Gastroenterology & Hepatology ◽

10.1080/17474124.2020.1784726 ◽

2020 ◽

Vol 14 (8) ◽

pp. 757-764

Author(s):

Kun Chen ◽

Xiaofang Deng ◽

Zhihao Yang ◽

Dongdong Yu ◽

Xiang Zhang ◽

...

Keyword(s):

Esophagogastric Junction ◽

Population Based ◽

Type Ii ◽

Population Based Study ◽

Siewert Type ◽

Siewert Type Ii

Download Full-text

Lower Mediastinal Lymph Node Metastasis is an Independent Survival Factor of Siewert Type II and III Adenocarcinomas in the Gastroesophageal Junction

The American Surgeon ◽

10.1177/000313481207800539 ◽

2012 ◽

Vol 78 (5) ◽

pp. 567-573 ◽

Cited By ~ 8

Author(s):

Masaki Nakamura ◽

Makoto Iwahashi ◽

Mikihito Nakamori ◽

Teiji Naka ◽

Toshiyasu Ojima ◽

...

Keyword(s):

Lymph Node ◽

Lymph Node Metastasis ◽

Mediastinal Lymph Node ◽

Type Ii ◽

Mediastinal Lymph Node Metastasis ◽

Siewert Type ◽

Survival Factors ◽

Siewert Type Ii ◽

Type Iii ◽

Node Metastasis

We examined clinicopathological features and surgical outcomes in patients with adenocarcinoma in the gastroesophageal junction (GEJ), while also analyzing the survival factors that have a prognostic impact. Between 1991 and 2009, 61 patients with tumors in the GEJ (Siewert type II and III) underwent primary surgical resection. Thirty of 61 patients had type II tumors (49.2%) and 31 had type III tumors (50.8%). The tumor size was larger in type III tumors than type II tumors ( P = 0.0026). The overall 5-year survival rates in patients with type II tumors and type III tumors were 44.2 per cent and 41.4 per cent, respectively, with no significant differences ( P = 0.1888). The independent survival factors were lower mediastinal lymph node metastasis ( P = 0.0323) and a noncurative resection ( P = 0.0442). The independent survival factors for patients who underwent curative resections were the tumor size ( P = 0.0422), M category ( P = 0.0489), and lower mediastinal lymph node metastasis ( P = 0.0482). This study showed lower mediastinal lymph node metastasis to be an independent survival factor, and also suggested that lower mediastinal lymph node metastasis was associated with distant metastasis in patients with adenocarcinoma in the GEJ (Siewert type II and III). Therefore, the preoperative early detection of such metastasis is important to improve patient survival.

Download Full-text