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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

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Abstract

Introduction

The distribution of lymph node metastases in locally advanced Siewert type I and type II AEG (adenocarcinoma of the esophagogastric junction) remains unclear. The diversity of data in the literature reflects the non-uniformity of tumor stages and surgical procedures in previous studies.

Materials and methods

Based on a retrospective analysis from our single-center database, we examined distributions of lymph node metastases in types I and II cT2-4 AEG. The dataset comprised 44 patients; 19 and 25 patients had type I and type II, respectively. All patients underwent subtotal esophagectomy and total mediastinal lymphadenectomy, which included dissection of the upper mediastinal lymph nodes. The histological data of the surgical specimens were analyzed to evaluate metastasis rates in each lymph node station according to the Japanese Esophageal Society (JES) and American Joint Committee on Cancer (AJCC) guidelines.

Results

Lymph node metastases were observed in 75.0% cases (n = 33/44). There was no significant difference in the total lymph node metastasis rate between the two groups (type I 73.7% versus type II 76.0%). On comparing each lymph node region separately, no statistically significant differences were noted between the groups: upper mediastinal (type I 31.6% versus type II 24.0%), middle and lower mediastinal (type I 31.6% versus type II 44.0%), paragastric (type I 61.1% versus type II 76.0%), and celiac lymph nodes (type I 16.7% versus type II 25.0%).

Conclusion

In advanced clinical stages, the metastasis rate is high at all mediastinal lymph node regions in both type I and type II AEGs.

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Abbreviations

AEG:

Adenocarcinoma of esophagogastric junction

AJCC:

American Joint Committee on Cancer

CT:

Chemotherapy

CRT:

Chemoradiation

DFS:

Disease-free survival

JES:

Japan Esophageal Society

LN:

Lymph node

OS:

Overall survival

UICC:

Union for International Cancer Control

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Authors and Affiliations

  1. Department of Esophageal Surgery, National Cancer Center Hospital, 5-1-1 Tsukiji, Chuo-ku Tokyo, 104-0045, Japan

    Akio Sakaki, Jun Kanamori, Koshiro Ishiyama, Daisuke Kurita, Junya Oguma & Hiroyuki Daiko

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  1. Akio Sakaki
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  2. Jun Kanamori
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  3. Koshiro Ishiyama
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  4. Daisuke Kurita
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  5. Junya Oguma
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  6. Hiroyuki Daiko
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Contributions

H. Daiko and A. Sakaki performed the study conception and design. A. Sakaki, K. Ishiyama, and D. Kurita acquired the data for this study from the prospectively maintained institutional database. A. Sakaki, J. Kanamori, and H. Daiko analyzed and interpreted the gathered data. This manuscript was drafted by A. Sakaki. H. Daiko, J. Kanamori, and J. Oguma critically revised the manuscript.

Corresponding author

Correspondence to Hiroyuki Daiko.

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The authors declare that they have no conflict of interest.

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Written informed consent was obtained from all patients in this study, which was approved by the Institutional Review Board of the National Cancer Center Hospital. All treatment was performed according to the ethical standards laid down in the Declaration of Helsinki.

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Sakaki, A., Kanamori, J., Ishiyama, K. et al. 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. Langenbecks Arch Surg 405, 509–519 (2020). https://doi.org/10.1007/s00423-020-01894-z

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