Skip to main content

Advertisement

Log in

Thoracic Lymph Node Involvement in Adenocarcinoma of the Esophagogastric Junction and Lower Esophageal Squamous Cell Carcinoma Relative to the Location of the Proximal End of the Tumor

  • Breast Oncology
  • Published:
Annals of Surgical Oncology Aims and scope Submit manuscript

Abstract

Background

It is difficult to determine preoperatively whether upper/middle thoracic lymphadenectomy is necessary in patients with adenocarcinoma of the esophagogastric junction (AEG) or lower esophageal squamous cell carcinoma (ESCC). Here, we investigated whether stratification based on the location of the proximal end of the tumor, as assessed using preoperative computed tomography (CT) images, would be useful for predicting upper/middle thoracic lymph node involvement for AEG and lower ESCC.

Methods

A total of 142 patients with AEG and lower ESCC treated by R0–1 surgical resection via a thoracotomy was retrospectively investigated. The location of the proximal end of the tumor in comparison with the vena cava foramen (VCF) was decided by inspecting preoperative CT images and then correlated with upper/middle thoracic lymph node involvement.

Results

The incidence of upper/middle thoracic lymph node involvement was low in AEG and ESCC tumors having proximal ends below the VCF (0 %, 0 of 13, and 5.9 %, 1 of 17, for AEG and ESCC, respectively). In contrast, when the tumors’ proximal ends were above the VCF, patients had higher frequencies of upper/middle thoracic lymph node involvement (36.4 %, 8 of 22, and 37.8 %, 34 of 90, for AEG and ESCC, respectively). Multivariate analysis showed that the location of the proximal end of the tumor is an independent risk factor related to upper/middle thoracic lymph node involvement (odds ratio 14.3, 95 % confidence interval 1.76–111, p = 0.013), whereas other clinical factors (cT, cN, tumor length, and histologic types) are not.

Conclusions

This manner of stratification using preoperative CT images could be useful in deciding the extent of thoracic lymphadenectomy in both AEG and ESCC.

This is a preview of subscription content, log in via an institution to check access.

Access this article

Price excludes VAT (USA)
Tax calculation will be finalised during checkout.

Instant access to the full article PDF.

Institutional subscriptions

Fig. 1
Fig. 2

Similar content being viewed by others

References

  1. Devesa SS, Blot WJ, Fraumeni JF Jr. Changing patterns in the incidence of esophageal and gastric carcinoma in the United States. Cancer. 1998;83:2049–53.

    Article  CAS  PubMed  Google Scholar 

  2. Dolan K, Sutton R, Walker SJ, Morris AI, Campbell F, Williams EM. New classification of oesophageal and gastric carcinomas derived from changing patterns in epidemiology. Br J Cancer. 1999;80:834–42.

    Article  CAS  PubMed Central  PubMed  Google Scholar 

  3. DeMeester SR. Adenocarcinoma of the esophagus and cardia: a review of the disease and its treatment. Ann Surg Oncol. 2006;13:12–30.

    Article  PubMed  Google Scholar 

  4. Hulscher JB, van Sandick JW, de Boer AG, et al. Extended transthoracic resection compared with limited transhiatal resection for adenocarcinoma of the esophagus. N Engl J Med. 2002;347:1662–9.

    Article  PubMed  Google Scholar 

  5. Lerut T, Decker G, Coosemans W, et al. Quality indicators of surgery for adenocarcinoma of the esophagus and gastroesophageal junction. Recent Results Cancer Res. 2010;182:127–42.

    Article  PubMed  Google Scholar 

  6. Sasako M, Sano T, Yamamoto S, et al. Left thoracoabdominal approach versus abdominal-transhiatal approach for gastric cancer of the cardia or subcardia: a randomised controlled trial. Lancet Oncol. 2006;7:644–51.

    Article  PubMed  Google Scholar 

  7. Barbour AP, Rizk NP, Gonen M, et al. Adenocarcinoma of the gastroesophageal junction: influence of esophageal resection margin and operative approach on outcome. Ann Surg. 2007;246:1–8.

    Article  PubMed Central  PubMed  Google Scholar 

  8. Schiesser M, Schneider PM. Surgical strategies for adenocarcinoma of the esophagogastric junction. Recent Results Cancer Res. 2010;182:93–106.

    Article  PubMed  Google Scholar 

  9. Leers JM, DeMeester SR, Chan N, et al. Clinical characteristics, biologic behavior, and survival after esophagectomy are similar for adenocarcinoma of the gastroesophageal junction and the distal esophagus. J Thorac Cardiovasc Surg. 2009;138:594–602; discussion 601–2.

    Article  PubMed  Google Scholar 

  10. Powell J, McConkey CC, Gillison EW, Spychal RT. Continuing rising trend in oesophageal adenocarcinoma. Int J Cancer. 2002;102:422–7.

    Article  CAS  PubMed  Google Scholar 

  11. Powell J, McConkey CC. The rising trend in oesophageal adenocarcinoma and gastric cardia. Eur J Cancer Prev. 1992;1:265–9.

    Article  CAS  PubMed  Google Scholar 

  12. Ito H, Inoue H, Odaka N, et al. Clinicopathological characteristics and optimal management for esophagogastric junctional cancer: a single center retrospective cohort study. J Exp Clin Cancer Res. 2013;32:2.

    Article  PubMed Central  PubMed  Google Scholar 

  13. Kakeji Y, Yamamoto M, Ito S, et al. Lymph node metastasis from cancer of the esophagogastric junction, and determination of the appropriate nodal dissection. Surg Today. 2012;42:351–8.

    Article  PubMed  Google Scholar 

  14. Siewert JR, Stein HJ. Classification of adenocarcinoma of the oesophagogastric junction. Br J Surg. 1998;85:1457–9.

    Article  CAS  PubMed  Google Scholar 

  15. Grotenhuis BA, Wijnhoven BP, Poley JW, et al. Preoperative assessment of tumor location and station-specific lymph node status in patients with adenocarcinoma of the gastroesophageal junction. World J Surg. 2013;37:147–55.

    Article  PubMed  Google Scholar 

  16. Akiyama H, Miyazono H, Tsurumaru M, Hashimoto C, Kawamura T. Thoracoabdominal approach for carcinoma of the cardia of the stomach. Am J Surg. 1979;137:345–9.

    Article  CAS  PubMed  Google Scholar 

  17. Matsubara T, Ueda M, Nagao N, Takahashi T, Nakajima T, Nishi M. Cervicothoracic approach for total mesoesophageal dissection in cancer of the thoracic esophagus. J Am Coll Surg. 1998;187:238–45.

    Article  CAS  PubMed  Google Scholar 

  18. Matsubara T, Ueda M, Nagao N, Takahashi T, Nakajima T, Nishi M. Surgical treatment for carcinoma of the thoracic esophagus with major involvement in the neck or upper mediastinum. J Surg Oncol. 1998;67:6–10.

    Article  CAS  PubMed  Google Scholar 

  19. Matsubara T, Ueda M, Yanagida O, Nakajima T, Nishi M. How extensive should lymph node dissection be for cancer of the thoracic esophagus? J Thorac Cardiovasc Surg. 1994;107:1073–8.

    CAS  PubMed  Google Scholar 

  20. Sobin L, Gospodarowicz M, Wittekind C. TNM classification of malignant tumours. 7th ed. New York: Wiley-Blackwell; 2009.

    Google Scholar 

  21. Omloo JM, Lagarde SM, Hulscher JB, et al. Extended transthoracic resection compared with limited transhiatal resection for adenocarcinoma of the mid/distal esophagus: five-year survival of a randomized clinical trial. Ann Surg. 2007;246:992–1000; discussion 1000–1.

    Article  PubMed  Google Scholar 

  22. Lerut T, Nafteux P, Moons J, et al. Three-field lymphadenectomy for carcinoma of the esophagus and gastroesophageal junction in 174 R0 resections: impact on staging, disease-free survival, and outcome—a plea for adaptation of TNM classification in upper-half esophageal carcinoma. Ann Surg. 2004;240:962–72; discussion 972–4.

    Article  CAS  PubMed Central  PubMed  Google Scholar 

  23. Altorki N, Kent M, Ferrara C, Port J. Three-field lymph node dissection for squamous cell and adenocarcinoma of the esophagus. Ann Surg. 2002;236:177–83.

    Article  PubMed Central  PubMed  Google Scholar 

  24. Ginsberg RJ, Rubinstein LV. Randomized trial of lobectomy versus limited resection for T1 N0 non-small cell lung cancer. Lung Cancer Study Group. Ann Thorac Surg. 1995;60:615–22; discussion 622–13.

    Article  CAS  PubMed  Google Scholar 

Download references

Disclosures

The authors declare no conflict of interest.

Author information

Authors and Affiliations

Authors

Corresponding author

Correspondence to Shinji Mine MD.

Rights and permissions

Reprints and permissions

About this article

Cite this article

Mine, S., Sano, T., Hiki, N. et al. Thoracic Lymph Node Involvement in Adenocarcinoma of the Esophagogastric Junction and Lower Esophageal Squamous Cell Carcinoma Relative to the Location of the Proximal End of the Tumor. Ann Surg Oncol 21, 1596–1601 (2014). https://doi.org/10.1245/s10434-014-3548-2

Download citation

  • Received:

  • Published:

  • Issue Date:

  • DOI: https://doi.org/10.1245/s10434-014-3548-2

Keywords

Navigation