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Risk factor of mediastinal lymph node metastasis of Siewert type I and II esophagogastric junction carcinomas

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Abstract

Background

Incidence of esophagogastric junction (EGJ) carcinoma has been increasing worldwide. Several studies revealed that the distance from the EGJ to the proximal edge of the primary tumor (esophageal invasion: EI) may be a significant indicator of metastasis in the mediastinal lymph nodes in patients with Siewert type II carcinomas. However, few studies have been conducted in patients with carcinomas located at Siewert type II sequentially to upper carcinomas (Siewert type I) for mediastinal metastasis regardless of histological types.

Methods

This was a single-center retrospective cohort study. EGJ carcinomas located at Siewert type I and II regions including both squamous cell carcinoma (SCC) and adenocarcinoma were analyzed in terms of lymph node metastasis patterns.

Results

We included 121 patients in this study. Thirty-three (27.3%) patients had SCC. In multivariate analysis, the distance of EI (> 20 mm) was an independent risk factor (OR 11.80, p = 0.005) for lower mediastinal lymph node metastasis. In terms of above the middle mediastinal metastasis, the distance of EI (> 30 m), histological type (SCC), and tumor size (> 40 mm) were risk factors in univariate analysis. Furthermore, EI was significant (OR 13.50, p = 0.026) in multivariate analysis.

Conclusions

The distance of EI was the independent risk factor for mediastinal lymph node metastasis, especially > 20 mm related with a higher risk for mediastinal lymph node metastasis. Furthermore, EGJ carcinoma patients who have EI > 30 mm, large SCC carcinoma, and multiple lymph node metastasis might be considered the middle-upper mediastinal lymph node dissection by transthoracic approach.

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Abbreviations

EI:

esophageal invasion

EGJ:

esophagogastric junction

SCC:

squamous cell carcinoma

TNM:

tumor-node-metastasis

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Acknowledgments

The authors thank Prof Hiroshi Morimatsu (Department of Anaesthesiology, Okayama University Graduate School of Medicine and Dentistry) for their professional cooperation during esophagectomy.

Funding

This work was supported by Grants-in-Aid from the Ministry of Education, Science, and Culture, Japan, and Grants from the Ministry of Health and Welfare, Japan. This work was supported by JSPS KAKENHI Grand Number JP90766114.

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Authors and Affiliations

  1. Department of Gastroenterological Surgery, Okayama University Graduate School of Medicine, Dentistry and Pharmaceutical Sciences, 2-5-1 Shikata-cho, Kita-ku, Okayama, 700-8558, Japan

    Noriyuki Nishiwaki, Kazuhiro Noma, Tatsuo Matsuda, Naoaki Maeda, Shunsuke Tanabe, Kazufumi Sakurama, Yasuhiro Shirakawa & Toshiyoshi Fujiwara

  2. Shigei Medical Research Institute, Okayama, Japan

    Kazufumi Sakurama

Authors
  1. Noriyuki Nishiwaki
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  2. Kazuhiro Noma
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  3. Tatsuo Matsuda
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  4. Naoaki Maeda
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  5. Shunsuke Tanabe
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  6. Kazufumi Sakurama
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  7. Yasuhiro Shirakawa
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  8. Toshiyoshi Fujiwara
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Contributions

Study conception and design: N. Nishiwaki, K. Noma, Y. Shirakawa, T. Fujiwara. Acquisition of data: N. Nishiwaki, K. Noma, T. Matsuda, N. Maeda, S. Tanabe, K. Sakurama. Analysis and interpretation of data: N. Nishiwaki, K. Noma, Y. Shirakawa, T.Fujiwara. Drafting of manuscript: N. Nishiwaki, K. Noma, Y. Shirakawa, T. Fujiwara. Critical revision of manuscript: T. Matsuda, N. Maeda, S. Tanabe, K. Sakurama, Y. Shirakawa, T.Fujiwara.

Corresponding author

Correspondence to Kazuhiro Noma.

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Conflict of interest

The authors declare that they have no conflict of interest.

Ethics approval

This study was performed in line with the principles of the Declaration of Helsinki. Approval was granted by the Ethics Committee of Okayama University Hospital (Approval No. 1903-006).

Informed consent

The requirement for informed consent from patients was waived because of its retrospective design.

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Not applicable.

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The authors declare that the work is original and has not been published previously.

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Nishiwaki, N., Noma, K., Matsuda, T. et al. Risk factor of mediastinal lymph node metastasis of Siewert type I and II esophagogastric junction carcinomas. Langenbecks Arch Surg 405, 1101–1109 (2020). https://doi.org/10.1007/s00423-020-02017-4

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  • DOI: https://doi.org/10.1007/s00423-020-02017-4

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