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Prognostic Significance of Hiatal Hernia in Patients with Gastric Cancer Located within the Upper-Third of the Stomach

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Abstract

Background

Gastric cancers located within the upper-third of the stomach (UGC), especially the esophagogastric junction GC (EGJGC), have distinct clinicopathological features due to their potential for multidirectional lymphatic spread. In this study, we investigated the clinical significance of hiatal hernias (HH) in patients with UGC, including EGJGC.

Methods

In this retrospective study, we assessed status of HH in 147 patients with UGC who underwent curative resection at our hospital and examined the correlation between the presence of HH (+) and multiple clinicopathological factors.

Results

Thirty-four patients (23%) were HH (+). However, we found no significant correlation between HH (+) and clinicopathological factors. HH (+) patients frequently developed lymph node recurrences. Prognosis was significantly better in patients with UGC and HH (−), compared to those with UGC and HH (+). Similarly, EGJGC patients who were HH (−) showed superior survival compared to HH (+) patients. Multivariate analysis found that the HH (+) (p = 0.004), histological type (p = 0.029), and nodal stage (p = 0.034) were independent prognostic factors.

Conclusions

The presence of HH might affect lymphatic spread of tumor cells, and consequently prognosis of patients with UGC. Therefore, special attention is needed in developing surgical and postoperative strategies for such patients with UGC who are HH (+).

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References

  1. Kamangar F, Dores GM, Anderson WF (2006) Patterns of cancer incidence, mortality, and prevalence across five continents: defining priorities to reduce cancer disparities in different geographic regions of the world. J Clin Oncol 24:2137–2150

    Article  Google Scholar 

  2. Cancer Genome Atlas Research Network (2014) Comprehensive molecular characterization of gastric adenocarcinoma. Nature 513:202–209

    Article  Google Scholar 

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

    Article  CAS  Google Scholar 

  4. Devesa SS, Blot WJ, Fraumeni JF Jr (1998) Changing patterns in the incidence of esophageal and gastric carcinoma in the United States. Cancer 83:2049–2053

    Article  CAS  Google Scholar 

  5. Bollschweiler E, Wolfgarten E, Gutschow C et al (2001) Demographic variations in the rising incidence of esophageal adenocarcinoma in white males. Cancer 92:549–555

    Article  CAS  Google Scholar 

  6. Crew KD, Neugut AI (2004) Epidemiology of upper gastrointestinal malignancies. Semin Oncol 31:450–464

    Article  Google Scholar 

  7. Dodds WJ (1977) 1976 Walter B. Cannon lecture: current concepts of esophageal motor function: clinical implications for radiology. AJR Am J Roentgenol 128:549–561

    Article  CAS  Google Scholar 

  8. Mittal RK (1997) Hiatal hernia: myth or reality? Am J Med 103:33s–39s

    Article  CAS  Google Scholar 

  9. Rudiger Siewert J, 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 232:353–361

    Article  CAS  Google Scholar 

  10. Clavien PA, Barkun J, de Oliveira ML et al (2009) The Clavien–Dindo classification of surgical complications: five-year experience. Ann Surg 250:187–196

    Article  Google Scholar 

  11. Japanese Gastric Cancer Association (2011) Japanese classification of gastric carcinoma: 3rd English edition. Gastric Cancer 14:101–112

    Article  Google Scholar 

  12. Makuuchi H (1982) Clinical study of sliding esophageal hernia—with special reference to the diagnostic criteria and classification of the severity of the disease. Nihon Shokakibyo Gakkai Zasshi 79:1557–1567

    CAS  PubMed  Google Scholar 

  13. Kanda Y (2013) Investigation of the freely available easy-to-use software ‘EZR’ for medical statistics. Bone Marrow Transplant 48:452–458

    Article  CAS  Google Scholar 

  14. Kurokawa Y, Hiki N, Yoshikawa T et al (2015) Mediastinal lymph node metastasis and recurrence in adenocarcinoma of the esophagogastric junction. Surgery 157:551–555

    Article  Google Scholar 

  15. 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 7:644–651

    Article  Google Scholar 

  16. Kurokawa Y, Sasako M, Sano T et al (2011) Functional outcomes after extended surgery for gastric cancer. Br J Surg 98:239–245

    Article  CAS  Google Scholar 

  17. Kurokawa Y, Sasako M, Sano T et al (2015) Ten-year follow-up results of a randomized clinical trial comparing left thoracoabdominal and abdominal transhiatal approaches to total gastrectomy for adenocarcinoma of the oesophagogastric junction or gastric cardia. Br J Surg 102:341–348

    Article  CAS  Google Scholar 

  18. 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 

  19. 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 

  20. Watanabe J, Ota M, Suwa Y et al (2017) Evaluation of lymph flow patterns in splenic flexural colon cancers using laparoscopic real-time indocyanine green fluorescence imaging. Int J Colorectal Dis 32:201–207

    Article  Google Scholar 

  21. Vasey CE, Rajaratnam S, O’Grady G et al (2018) Lymphatic drainage of the splenic flexure defined by intraoperative scintigraphic mapping. Dis Colon Rectum 61:441–446

    Article  Google Scholar 

Download references

Acknowledgements

The authors are grateful to Makiko Mishina for expert technical assistance.

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Authors and Affiliations

  1. First Department of Surgery, Faculty of Medicine, University of Yamanashi, 1110 Shimokato, Chuo, Yamanashi, 409-3898, Japan

    Suguru Maruyama, Yoshihiko Kawaguchi, Hidenori Akaike, Kensuke Shiraishi, Ryo Saito, Hiroki Shimizu, Shinji Furuya, Naohiro Hosomura, Hidetake Amemiya, Hiromichi Kawaida, Makoto Sudo, Shingo Inoue, Hiroshi Kono & Daisuke Ichikawa

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  1. Suguru Maruyama
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  2. Yoshihiko Kawaguchi
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  3. Hidenori Akaike
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  4. Kensuke Shiraishi
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  5. Ryo Saito
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  6. Hiroki Shimizu
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  12. Shingo Inoue
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  14. Daisuke Ichikawa
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Corresponding author

Correspondence to Daisuke Ichikawa.

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The authors declare that they have no conflict of interest.

Ethical standard

This study was approved by the Ethics Committee of the Yamanashi University and was performed in accordance with the ethical standards of the Declaration of Helsinki and its later amendments.

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All study participants provided informed written consent prior to their study enrollment.

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Maruyama, S., Kawaguchi, Y., Akaike, H. et al. Prognostic Significance of Hiatal Hernia in Patients with Gastric Cancer Located within the Upper-Third of the Stomach. World J Surg 44, 863–868 (2020). https://doi.org/10.1007/s00268-019-05236-z

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  • DOI: https://doi.org/10.1007/s00268-019-05236-z

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