Pattern of Lymph Node Metastasis for Siewert Type Ⅱ Adenocarcinoma of The Esopha-gogastric Junction and the Choice of Surgical Approach_Chinese Journal of Clinical Thoracic and Cardiovascular Surgery

Authors：

CAIJie , PENGJun , WANGWen-ping , JIXiang ,  CHENLong-qi

Department of Thoracic Surgery, West China Hospital of Sichuan University, Chengdu 610041, P. R. China;

Corresponding author：

CHENLong-qi, Email: drchenlq@gmail.com

Keywords：

Adenocarcinoma of the esophagogastric junction; Lymph node metastasis; Surgical approach

DOI：

10.7507/1007-4848.20160034

Video：

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Objective To discuss the pattern of lymph node metastasis for Siewert type Ⅱ adenocarcinoma of the esophagogastric junction and its appropriate surgical approach. Methods We retrospectively analyzed the clinical data of 162 patients with Siewert type Ⅱ adenocarcinoma of the esophagogastric junction who underwent curative resection in West China Hospital of Sichuan University from January 2007 through February 2010. The patients were divided into three groups based on their surgical approach, including 96 patients in a left thoracic group, 20 patients in an Ivor-Lewis group and 46 patients in an abdominal group. Results There were 120 patients with lymph node metastasis. The lymph node metastatic rate was 74.1%. Simple thoracic lymph node metastasis was observed only in 2 patients (1.7%), 98 patients (81.7%) with simple abdominal lymph node metastasis, and 20 patients (16.6%) with both capacity lymph node metastasis. The thoracic approaches had an advantage in dissection lower mediastinal lymph node over the abdominal approach, while for the abdominal lymph node the result was reversed. There are 11 groups of lymph node with a more than 10% metastatic rate. Conclusions The abdominal lymph nodes are the dominating metastatic area of Siewert type Ⅱ AEG, but some important groups of lower mediastinal lymph node should be removed. In terms of curative resection of tumor, the Ivor-Lewis operated by a thoracic surgeon who is more familiar with the abdominal lymph node may be a reasonable choice.

Citation： CAIJie, PENGJun, WANGWen-ping, JIXiang, CHENLong-qi. Pattern of Lymph Node Metastasis for Siewert Type Ⅱ Adenocarcinoma of The Esopha-gogastric Junction and the Choice of Surgical Approach. Chinese Journal of Clinical Thoracic and Cardiovascular Surgery, 2016, 23(2): 151-155. doi: 10.7507/1007-4848.20160034 Copy

1.	Hasegawa S, Yoshikawa T. Adenocarcinoma of the esophagogastric junction: incidence, characteristics, and treatment strategies. Gastric cancer, 2010, 13(2): 63-73.
2.	Ielpo B, Pernaute AS, Elia S, et al. Impact of number and site of lymph node invasion on survival of adenocarcinoma of esophago-gastric junction. Interact Cardiovasc Thorac Surg, 2010, 10(5): 704-708.
3.	Siewert JR, Holscher AH, Becker K, et al. Cardia cancer: attempt at a therapeutically relevant classification . Chirurg, 1987, 58(1): 25-32.
4.	Mariette C, Piessen G, Briez N, et al. Oesophagogastric junction adenocarcinoma: which therapeutic approach? Lancet Oncol, 2011, 12(3): 296-305.
5.	Siewert JR, Feith M, Stein HJ. Biologic and clinical variations of adenocarcinoma at the esophago-gastric junction: relevance of a topographic-anatomic subclassification. J Surg Oncol, 2005, 90(3): 139-146.
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(8): 644-651.
7.	Goto H, Tokunaga M, Miki Y, et al. 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, 2015, 18(2): 375-381.
8.	Casson AG, Rusch VW, Ginsberg RJ, et al. Lymph node mapping of esophageal cancer. Ann Thorac Surg, 1994, 58(5): 1569-1570.
9.	Takubo K, Makuuchi H, Fujita H, et al. Japanese classification of esophageal cancer, tenth edition: part I. Esophagus, 2009, 6(1): 1-25.
10.	Zhang H, Wang W, Cheng Y, et al. Adenocarcinomas of the esophagogastric junction: experiences at a single institution in China . World J Surg Oncol, 2013, 11: 155.
11.	Hosokawa Y, Kinoshita T, Konishi M, et al. Clinicopathological features and prognostic factors of adenocarcinoma of the esophago-gastric junction according to Siewert classification: experiences at a single institution in Japan. Ann Surg Oncol, 2012, 19(2): 677-683.
12.	李守淼, 李子禹, 季鑫. SiewertⅡ型胃食管结合部腺癌淋巴结转移的特点. 中华肿瘤杂志, 2013, 35(4): 288-291.
13.	Yamashita H, Katai H, Morita S, et al. Optimal extent of lymph node dissection for Siewert type Ⅱ esophagogastric junction carcinoma . Ann Surg, 2011, 254(2): 274-280.
14.	Goto H, Tokunaga M, Miki Y, et al. 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, 2014, [Epub ahead of print].
15.	Pedrazzani C, De manzoni G, Marrelli D, et al. Lymph node involve-ment in advanced gastroesophageal junction adenocarcinoma . J Thorac Cardiovasc Surg, 2007, 134(2): 378-385.
16.	陈希, 胡祥, 曹亮. Siewert Ⅱ型和Ⅲ型食管胃结合部腺癌的淋巴结转移规律. 中华消化外科杂志, 2014, 13(2): 115-119.
17.	刘巍, 郝希山, 陈勇, 等. 1526例胸段食管癌及贲门癌淋巴结转移状况分析(附1996~2004年河北医科大学第四医院随机抽样报告) . 中国肿瘤临床, 2008, 35(11): 601-605.
18.	Rüdiger Siewert J, Feith M, Werner M, et al. Adenocarcinoma of the esophagogastric junction: results of surgical therapy based on anatomical/topographic classification in 1,002 consecutive patients. Ann Surg, 2000, 232(3): 353-361.
19.	周金哲, 周岩冰, 沈毅, 等. Siewert Ⅱ型和Ⅲ型食管胃结合部腺癌经胸与经腹食管裂孔手术的疗效比较. 中华消化外科杂志, 2014, 13(2): 105-109.
20.	Feith M, Stein HJ, Siewert JR. Adenocarcinoma of the esophagogas-tric junction: surgical therapy based on 1602 consecutive resected patients. Surg Oncol Clin N Am, 2006, 15(4): 751-764.
21.	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.
22.	Wolff CS, Castillo SF, Larson DR, et al. Ivor Lewis approach is superior to transhiatal approach in retrieval of lymph nodes at esophagectomy. Dis Esophagus, 2008, 21(4): 328-333.
23.	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): 1-8.

1. Hasegawa S, Yoshikawa T. Adenocarcinoma of the esophagogastric junction: incidence, characteristics, and treatment strategies. Gastric cancer, 2010, 13(2): 63-73.
2. Ielpo B, Pernaute AS, Elia S, et al. Impact of number and site of lymph node invasion on survival of adenocarcinoma of esophago-gastric junction. Interact Cardiovasc Thorac Surg, 2010, 10(5): 704-708.
3. Siewert JR, Holscher AH, Becker K, et al. Cardia cancer: attempt at a therapeutically relevant classification . Chirurg, 1987, 58(1): 25-32.
4. Mariette C, Piessen G, Briez N, et al. Oesophagogastric junction adenocarcinoma: which therapeutic approach? Lancet Oncol, 2011, 12(3): 296-305.
5. Siewert JR, Feith M, Stein HJ. Biologic and clinical variations of adenocarcinoma at the esophago-gastric junction: relevance of a topographic-anatomic subclassification. J Surg Oncol, 2005, 90(3): 139-146.
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(8): 644-651.
7. Goto H, Tokunaga M, Miki Y, et al. 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, 2015, 18(2): 375-381.
8. Casson AG, Rusch VW, Ginsberg RJ, et al. Lymph node mapping of esophageal cancer. Ann Thorac Surg, 1994, 58(5): 1569-1570.
9. Takubo K, Makuuchi H, Fujita H, et al. Japanese classification of esophageal cancer, tenth edition: part I. Esophagus, 2009, 6(1): 1-25.
10. Zhang H, Wang W, Cheng Y, et al. Adenocarcinomas of the esophagogastric junction: experiences at a single institution in China . World J Surg Oncol, 2013, 11: 155.
11. Hosokawa Y, Kinoshita T, Konishi M, et al. Clinicopathological features and prognostic factors of adenocarcinoma of the esophago-gastric junction according to Siewert classification: experiences at a single institution in Japan. Ann Surg Oncol, 2012, 19(2): 677-683.
12. 李守淼, 李子禹, 季鑫. SiewertⅡ型胃食管结合部腺癌淋巴结转移的特点. 中华肿瘤杂志, 2013, 35(4): 288-291.
13. Yamashita H, Katai H, Morita S, et al. Optimal extent of lymph node dissection for Siewert type Ⅱ esophagogastric junction carcinoma . Ann Surg, 2011, 254(2): 274-280.
14. Goto H, Tokunaga M, Miki Y, et al. 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, 2014, [Epub ahead of print].
15. Pedrazzani C, De manzoni G, Marrelli D, et al. Lymph node involve-ment in advanced gastroesophageal junction adenocarcinoma . J Thorac Cardiovasc Surg, 2007, 134(2): 378-385.
16. 陈希, 胡祥, 曹亮. Siewert Ⅱ型和Ⅲ型食管胃结合部腺癌的淋巴结转移规律. 中华消化外科杂志, 2014, 13(2): 115-119.
17. 刘巍, 郝希山, 陈勇, 等. 1526例胸段食管癌及贲门癌淋巴结转移状况分析(附1996~2004年河北医科大学第四医院随机抽样报告) . 中国肿瘤临床, 2008, 35(11): 601-605.
18. Rüdiger Siewert J, Feith M, Werner M, et al. Adenocarcinoma of the esophagogastric junction: results of surgical therapy based on anatomical/topographic classification in 1,002 consecutive patients. Ann Surg, 2000, 232(3): 353-361.
19. 周金哲, 周岩冰, 沈毅, 等. Siewert Ⅱ型和Ⅲ型食管胃结合部腺癌经胸与经腹食管裂孔手术的疗效比较. 中华消化外科杂志, 2014, 13(2): 105-109.
20. Feith M, Stein HJ, Siewert JR. Adenocarcinoma of the esophagogas-tric junction: surgical therapy based on 1602 consecutive resected patients. Surg Oncol Clin N Am, 2006, 15(4): 751-764.
21. 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.
22. Wolff CS, Castillo SF, Larson DR, et al. Ivor Lewis approach is superior to transhiatal approach in retrieval of lymph nodes at esophagectomy. Dis Esophagus, 2008, 21(4): 328-333.
23. 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): 1-8.

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Pattern of Lymph Node Metastasis for Siewert Type Ⅱ Adenocarcinoma of The Esopha-gogastric Junction and the Choice of Surgical Approach

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