World Journal of Surgery

, Volume 40, Issue 7, pp 1672–1679 | Cite as

Clinicopathological Characteristics and Prognostic Factors of Patients with Siewert Type II Esophagogastric Junction Carcinoma: A Retrospective Multicenter Study

  • Tatsuo Matsuda
  • Yukinori Kurokawa
  • Takaki Yoshikawa
  • Kentaro Kishi
  • Kazunari Misawa
  • Masaki Ohi
  • Shinji Mine
  • Naoki Hiki
  • Hiroya Takeuchi
Original Scientific Report



The incidence of esophagogastric junction (EGJ) carcinoma is increasing, but its optimal surgical management remains controversial.


We retrospectively reviewed the database of 400 patients with Siewert type II EGJ carcinoma who were treated surgically at 7 institutions between March 1986 and October 2010. We examined the clinicopathological characteristics, prognostic factors, and risk factors associated with each recurrence pattern.


The 5-year overall survival rate of all patients with Siewert type II EGJ carcinoma was 58.4 %. Multivariate analysis showed that T and N stages were independent prognostic factors. We also found that the incidence of lower mediastinal lymph node metastasis (17.7 %) and para-aortic lymph node metastasis (16.1 %) was relatively high. In addition, the para-aortic lymph nodes (N = 39, 9.8 %) were the most frequent node recurrence site, followed by the mediastinal lymph nodes (N = 23, 5.8 %). Lung recurrence was more common than was peritoneal recurrence. Considering each type of recurrence, multivariate analysis showed that the differentiated type was associated with a higher risk of lung recurrence than was the undifferentiated type, and N stage (pN2–3) and positive venous invasion were independent risk factors for liver recurrence.


This study is one of the largest retrospective studies to evaluate patients with Siewert type II EGJ carcinoma. Para-aortic and mediastinal lymph node metastasis and recurrence rates were relatively high. During the postoperative follow-up of patients with differentiated Siewert type II EGJ carcinoma, patients should be monitored for lung recurrence more closely than that for peritoneal recurrence.


Mediastinal Lymph Node Recurrence Pattern Peritoneal Recurrence Mediastinal Lymph Node Dissection Liver Recurrence 
These keywords were added by machine and not by the authors. This process is experimental and the keywords may be updated as the learning algorithm improves.



We thank Prof. Yuichiro Doki and Prof. Yuko Kitagawa for supervising this study. This study received no grant support.

Compliance with ethical standards

Conflict of interest

The authors declare no conflicts of interest.


  1. 1.
    Blot WJ, Devesa SS, Kneller RW et al (1991) Rising incidence of adenocarcinoma of the esophagus and gastric cardia. JAMA 265:1287–1289CrossRefPubMedGoogle Scholar
  2. 2.
    Devesa SS, Blot WJ, Fraumeni JF Jr (1998) Changing patterns in the incidence of esophageal and gastric carcinoma in the United States. Cancer 83:2049–2053CrossRefPubMedGoogle Scholar
  3. 3.
    Hansen S, Wiig JN, Giercksky KE et al (1997) Esophageal and gastric carcinoma in Norway 1958–1992: incidence time trend variability according to morphological subtypes and organ subsites. Int J Cancer 71:340–344CrossRefPubMedGoogle Scholar
  4. 4.
    Siewert JR, Stein HJ (1998) Classification of adenocarcinoma of the oesophagogastric junction. Br J Surg 85:1457–1459CrossRefPubMedGoogle Scholar
  5. 5.
    Yamashita H, Katai H, Morita S et al (2011) Optimal extent of lymph node dissection for Siewert type II esophagogastric junction carcinoma. Ann Surg 254:274–280CrossRefPubMedGoogle Scholar
  6. 6.
    Hosokawa Y, Kinoshita T, Konishi M et al (2012) Clinicopathological features and prognostic factors of adenocarcinoma of the esophagogastric junction according to Siewert classification: experiences at a single institution in Japan. Ann Surg Oncol 19:677–683CrossRefPubMedGoogle Scholar
  7. 7.
    Ito H, Inoue H, Odaka N et al (2013) Clinicopathological characteristics and optimal management for esophagogastric junctional cancer; a single center retrospective cohort study. J Exp Clin Cancer Res 32:2CrossRefPubMedPubMedCentralGoogle Scholar
  8. 8.
    Omloo JM, Lagarde SM, Hulscher JB et al (2007) 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 246:992–1000CrossRefPubMedGoogle Scholar
  9. 9.
    Sasako M, Sano T, Yamamoto S et al (2006) Left thoracoabdominal approach versus abdominal-transhiatal approach for gastric cancer of the cardia or subcardia: a randomised controlled trial. Lancet Oncol 7:644–651CrossRefPubMedGoogle Scholar
  10. 10.
    Siewert JR, Feith M, Werner M et al (2000) Adenocarcinoma of the esophagogastric junction: results of surgical therapy based on anatomical/topographic classification in 1,002 consecutive patients. Ann Surg 232:353–361CrossRefGoogle Scholar
  11. 11.
    Sobin LH, Gospodarowicz MK, Wittekind CH (2009) TNM classification of malignant tumours, 7th edn. Wiley-Blackwell, New YorkGoogle Scholar
  12. 12.
    Waymann J, Bennett MK, Raimes SA et al (2002) The pattern of recurrence of adenocarcinoma of the oesophago-gastric junction. Br J Cancer 86:1223–1229CrossRefGoogle Scholar
  13. 13.
    Hulscher JB, van Sandick JW, Tijssen JG et al (2000) The recurrence pattern of esophageal carcinoma after transhiatal resection. J Am Coll Surg 191:143–148CrossRefPubMedGoogle Scholar
  14. 14.
    Zhang J, Niu Z, Zhou Y, Cao S (2013) A comparison between the seventh and sixth editions of the American Joint Committee on Cancer/International Union Against classification of gastric cancer. Ann Surg 257:81–86CrossRefPubMedGoogle Scholar
  15. 15.
    Sasako M, Sano T, Yamamoto S et al (2008) D2 lymphadenectomy alone or with para-aortic nodal dissection for gastric cancer. N Engl J Med 359:453–462CrossRefPubMedGoogle Scholar
  16. 16.
    HosokawaY Kinoshita T, Konishi M et al (2014) Recurrence patterns of esophagogastric junction adenocarcinoma according to Siewert’s classification after radical resection. Anticancer Res 34:4391–4397Google Scholar
  17. 17.
    Katai H, Maruyama K, Sasako M et al (1994) Mode of recurrence after Gastric cancer Surgery. Dig Surg 11:99–103CrossRefGoogle Scholar
  18. 18.
    Maehara Y, Hasuda S, Koga T et al (2000) Postoperative outcome and sites of recurrence in patients following curative resection of gastric cancer. Br J Surg 87:353–357CrossRefPubMedGoogle Scholar

Copyright information

© Société Internationale de Chirurgie 2016

Authors and Affiliations

  • Tatsuo Matsuda
    • 1
    • 7
  • Yukinori Kurokawa
    • 2
  • Takaki Yoshikawa
    • 3
  • Kentaro Kishi
    • 4
  • Kazunari Misawa
    • 5
  • Masaki Ohi
    • 6
  • Shinji Mine
    • 7
  • Naoki Hiki
    • 7
  • Hiroya Takeuchi
    • 1
  1. 1.Department of SurgeryKeio University School of MedicineTokyoJapan
  2. 2.Department of Gastroenterological SurgeryOsaka University Graduate School of MedicineOsakaJapan
  3. 3.Department of SurgeryKanagawa Cancer CenterYokohamaJapan
  4. 4.Department of SurgeryOsaka Medical Center for Cancer and Cardiovascular DiseasesOsakaJapan
  5. 5.Department of Gastroenterological SurgeryAichi Cancer Center HospitalNagoyaJapan
  6. 6.Department of SurgeryMie University Graduate School of MedicineMieJapan
  7. 7.Department of Gastroenterological SurgeryCancer Institute Hospital, Japanese Foundation for Cancer ResearchTokyoJapan

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