Skip to main content

Advertisement

SpringerLink
Log in

Clinical significance of lower perigastric lymph nodes dissection in Siewert type II/III adenocarcinoma of esophagogastric junction: a retrospective propensity score matched study

  • Original Article
  • Published:
Langenbeck's Archives of Surgery Aims and scope Submit manuscript

Abstract

Purpose

The optimal surgical procedure, whether total gastrectomy (TG) or proximal gastrectomy (PG), for Siewert type II/III adenocarcinoma of esophagogastric junction (AEG) has not been standardised, primarily because the optimal extent of lymph node (LN) dissection for AEG based on the metastatic rate of perigastric LNs remains under debate. The aim of this study was to investigate the metastatic incidence and prognostic significance of lower perigastric lymph nodes (LPLN), including No.4d, 5, 6 and 12a LN stations, in Siewert type II/III AEG.

Methods

A total of 701 patients with Siewert type II/III AEG who received transabdominal open gastrectomy (425 patients with TG and 276 patients with PG) from 2010 to 2015 in West China Hospital were retrospectively included. Based on the clinicopathological information of TG patients, the risk factors of LPLN-positive patients were evaluated, and the metastatic incidence as well as the therapeutic value (TV) index of each LN station was assessed. Moreover, the 5-year overall survival (OS) rates between LPLN-positive and LPLN-negative groups were compared in TG patients, and the postoperative survival difference between TG and PG patients was also compared, using propensity score matching (PSM) method.

Results

Tumour size (≥ 5 cm, OR = 1.481, p = 0.002) and pT stage (pT4, OR = 2.755, p = 0.024) were significant risk factors for patients with LPLN metastasis. For patients with tumour size more than 5 cm or pT4 stage, the metastatic rates of LPLN for Siewert type II, III and II/III AEG were 31.67%, 34.69% and 33.03%, whereas the TV indexes of LPLN for them were 5.76, 5.62 and 5.38, respectively. LPLN was a significant independent prognostic factor (HR = 1.422, p = 0.028), and positive LPLN was related to worse prognosis (p < 0.05). For patients with tumour size more than 5 cm or pT4 stage, TG patients were illustrated to have a better prognosis than PG patients, with 5-year OS rates of 58.9% vs 38.2% for Siewert type II AEG (χ2 = 4.159, p = 0.041), 68.9% vs 50.2% for Siewert type III AEG (χ2 = 5.630, p = 0.018) and 65.1% vs 40.3% for Siewert type II/III AEG (χ2 = 12.604, p < 0.001), respectively.

Conclusions

LPLN metastasis is a poor prognostic factor for patients with Siewert II/III AEG. LPLN dissection may improve the long-term survival of patients with tumour size more than 5 cm or pT4 stage, and TG might be more suitable for this kind of cancer.

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

Access this article

Log in via an institution

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

Instant access to the full article PDF.

Institutional subscriptions

Fig. 1
Fig. 2
Fig. 3

Similar content being viewed by others

Data availability

The datasets used and/or analysed during the current study are available from the corresponding author on reasonable request.

Code availability

Not applicable.

References

  1. Liu K, Yang K, Zhang W et al (2016) Changes of esophagogastric junctional adenocarcinoma and gastroesophageal reflux disease among surgical patients during 1988–2012: a single-institution, high-volume experience in China. Ann Surg 263:88–95

    Article  Google Scholar 

  2. Trivers KF, Sabatino SA, Stewart SL (2008) Trends in esophageal cancer incidence by histology, United States, 1998–2003. Int J Cancer 123:1422–1428

    Article  CAS  Google Scholar 

  3. Yamashita H, Seto Y, Sano T et al (2017) Results of a nation-wide retrospective study of lymphadenectomy for esophagogastric junction carcinoma. Gastric Cancer 20:69–83

    Article  CAS  Google Scholar 

  4. Kurokawa Y, Takeuchi H, Doki Y et al (2019) Mapping of lymph node metastasis from esophagogastric junction tumors: a prospective nationwide multicenter study. Ann Surg. https://doi.org/10.1097/SLA.0000000000003499

    Article  PubMed  Google Scholar 

  5. Siewert JR, Stein HJ (1998) Classification of adenocarcinoma of the oesophagogastric junction. Br J Surg 85:1457–1459

    Article  CAS  Google Scholar 

  6. Mariette C, Piessen G, Briez N et al (2011) Oesophagogastric junction adenocarcinoma: which therapeutic approach? Lancet Oncol 12:296–305

    Article  Google Scholar 

  7. Japanese Gastric Cancer Association. Japanese gastric cancer treatment guidelines 2018 (5th edition). Gastric Cancer. 2021; 24:1–21.

  8. Zhu K, Xu Y, Fu J et al (2019) Proximal gastrectomy versus total gastrectomy for Siewert type II adenocarcinoma of the esophagogastric junction: a comprehensive analysis of data from the SEER registry. Dis Markers 2019:9637972

    PubMed  PubMed Central  Google Scholar 

  9. Huh YJ, Lee HJ, Oh SY et al (2015) Clinical outcome of modified laparoscopy-assisted proximal gastrectomy compared to conventional proximal gastrectomy or total gastrectomy for upper-third early gastric cancer with special references to postoperative reflux esophagitis. J Gastric Cancer 15:191–200

    Article  Google Scholar 

  10. Sato Y, Katai H, Ito M et al (2018) Can proximal gastrectomy be justified for advanced adenocarcinoma of the esophagogastric junction? J Gastric Cancer 18:339–347

    Article  Google Scholar 

  11. Goto H, Tokunaga M, Miki Y et al (2014) The optimal extent of lymph node dissection for adenocarcinoma of the esophagogastric junction differs between Siewert type II and Siewert type III patients. Gastric Cancer 18:375–381

    Article  Google Scholar 

  12. Pu YW, Gong W, Wu YY, et al. Proximal gastrectomy versus total gastrectomy for proximal gastric carcinoma. A meta-analysis on postoperative complications, 5-year survival, and recurrence rate. Saudi Med J. 2013; 34:1223–8.

  13. Japanese Gastric Cancer Association. Japanese gastric cancer treatment guidelines 2010 (ver. 3). Gastric Cancer. 2011; 14:113–23.

  14. Washington K (2010) 7th edition of the AJCC cancer staging manual: stomach. Ann Surg Oncol 17:3077–3079

    Article  Google Scholar 

  15. Sasako M, McCulloch P, Kinoshita T et al (1995) New method to evaluate the therapeutic value of lymph node dissection for gastric cancer. Br J Surg 82:346–351

    Article  CAS  Google Scholar 

  16. Yamashita H, Katai H, Morita S et al (2011) Optimal extent of lymph node dissection for Siewert type II esophagogastric junction carcinoma. Ann Surg 254:274–280

    Article  Google Scholar 

  17. Zhao LY, Wang JJ, Zhao YL et al (2018) Superiority of tumor location-modified lauren classification system for gastric cancer: a multi-institutional validation analysis. Ann Surg Oncol 25:3257–3263

    Article  Google Scholar 

  18. Cao H, Ooi M, Yu Z et al (2019) Should pyloric lymph nodes be dissected for siewert type II and III adenocarcinoma of the esophagogastric junctions: experience from a high-volume center in China. J Gastrointest Surg 23:256–263

    Article  Google Scholar 

  19. Sugoor P, Shah S, Dusane R et al (2016) Proximal gastrectomy versus total gastrectomy for proximal third gastric cancer: total gastrectomy is not always necessary. Langenbecks Arch Surg 401:687–697

    Article  Google Scholar 

  20. Hasegawa S, Yoshikawa T, Rino Y et al (2013) Priority of lymph node dissection for Siewert type II/III adenocarcinoma of the esophagogastric junction. Ann Surg Oncol 20:4252–4259

    Article  Google Scholar 

  21. Hosoda K, Yamashita K, Moriya H et al (2017) Optimal treatment for Siewert type II and III adenocarcinoma of the esophagogastric junction: a retrospective cohort study with long-term follow-up. World J Gastroenterol 23:2723–2730

    Article  Google Scholar 

  22. Yoshikawa T, Takeuchi H, Hasegawa S et al (2016) Theoretical therapeutic impact of lymph node dissection on adenocarcinoma and squamous cell carcinoma of the esophagogastric junction. Gastric Cancer 19:143–149

    Article  CAS  Google Scholar 

  23. Wang JB, Lin MQ, Li P et al (2017) The prognostic relevance of parapyloric lymph node metastasis in Siewert type II/III adenocarcinoma of the esophagogastric junction. Eur J Surg Oncol 43:2333–2340

    Article  Google Scholar 

  24. Mine S, Kurokawa Y, Takeuchi H et al (2015) Distribution of involved abdominal lymph nodes is correlated with the distance from the esophagogastric junction to the distal end of the tumor in Siewert type II tumors. Eur J Surg Oncol 41:1348–1353

    Article  CAS  Google Scholar 

Download references

Funding

This study was supported by (1) National Natural Science Foundation of China (No.8210102679); (2) Sichuan Science and Technology Program (No.20YYJC3357, No.2021YFS0111).

Author information

Author notes

  1. Zong-lin Li and Lin-Yong Zhao contributed equally to this work.

Authors and Affiliations

  1. Department of Gastrointestinal Surgery and Laboratory of Gastric Cancer, State Key Laboratory of Biotherapy, West China Hospital, Sichuan University, and Collaborative Innovation Center for Biotherapy, Sichuan Province, No. 37 Guo Xue Xiang Street, Chengdu, 610041, China

    Zong-Lin Li, Lin-Yong Zhao, Wei-Han Zhang, Kai Liu, Hua-Yang Pang, Xiao-Long Chen, Xin-Zu Chen, Kun Yang & Jian-Kun Hu

Authors
  1. Zong-Lin Li
    View author publications

    You can also search for this author in PubMed Google Scholar

  2. Lin-Yong Zhao
    View author publications

    You can also search for this author in PubMed Google Scholar

  3. Wei-Han Zhang
    View author publications

    You can also search for this author in PubMed Google Scholar

  4. Kai Liu
    View author publications

    You can also search for this author in PubMed Google Scholar

  5. Hua-Yang Pang
    View author publications

    You can also search for this author in PubMed Google Scholar

  6. Xiao-Long Chen
    View author publications

    You can also search for this author in PubMed Google Scholar

  7. Xin-Zu Chen
    View author publications

    You can also search for this author in PubMed Google Scholar

  8. Kun Yang
    View author publications

    You can also search for this author in PubMed Google Scholar

  9. Jian-Kun Hu
    View author publications

    You can also search for this author in PubMed Google Scholar

Contributions

Study conception and design: Jian-Kun Hu, Zong-Lin Li and Lin-Yong Zhao. Acquisition of data: Zong-Lin Li, Lin-Yong Zhao, Wei-Han Zhang and Kai Liu. Analysis and interpretation of data: Zong-Lin Li and Lin-Yong Zhao. Drafting of manuscript: Zong-Lin Li and Lin-Yong Zhao. Critical revision of manuscript: Wei-Han Zhang, Kai Liu, Hua-Yang Pang, Xiao-Long Chen, Xin-Zu Chen and Kun Yang. Final approval of the version to be published: Jian-Kun Hu.

Corresponding author

Correspondence to Jian-Kun Hu.

Ethics declarations

Ethics approval

This study was based on the information gathered from the database of the Surgical Gastric Cancer Patient Registry of West China Hospital (WCHSGCPR) with the registration number WCH-SGCPR-2020–07, and the establishment of this database was approved by the Research Ethics Committee of West China Hospital (No.2014–215). Informed consent was obtained from the patients or their guardians.

Consent for publication

Not applicable.

Conflict of interest

The authors declare no competing interests.

Additional information

Publisher’s note

Springer Nature remains neutral with regard to jurisdictional claims in published maps and institutional affiliations.

Rights and permissions

Reprints and permissions

About this article

Check for updates. Verify currency and authenticity via CrossMark

Cite this article

Li, ZL., Zhao, LY., Zhang, WH. et al. Clinical significance of lower perigastric lymph nodes dissection in Siewert type II/III adenocarcinoma of esophagogastric junction: a retrospective propensity score matched study. Langenbecks Arch Surg 407, 985–998 (2022). https://doi.org/10.1007/s00423-021-02380-w

Download citation

  • Received:

  • Accepted:

  • Published:

  • Issue Date:

  • DOI: https://doi.org/10.1007/s00423-021-02380-w

Keywords

Search

Navigation