Mediastinal lymph node metastasis and recurrence in adenocarcinoma of the esophagogastric junction

Yukinori Kurokawa, Naoki Hiki, Takaki Yoshikawa, Kentaro Kishi, Yuichi Ito, Masaki Ohi, Noriko Wada, Shuji Takiguchi, Shinji Mine, Shinichi Hasegawa, Tatsuo Matsuda, Hiroya Takeuchi

Research output: Contribution to journalArticle

25 Citations (Scopus)

Abstract

Background Whether thorough mediastinal dissection is indicated in patients with Siewert type II adenocarcinoma of the esophagogastric junction (EGJ) remains controversial. We conducted a multicenter study to find a preoperative indicator of mediastinal node metastasis. Methods We retrospectively collected data on 315 patients with pT2-T4 Siewert type II tumors who underwent R0 or R1 resection. The rates of metastasis or recurrence were investigated for the upper, middle, and lower mediastinal lymph nodes. Multivariate logistic analysis was used to identify significant indicators of metastasis or recurrence in the mediastinal nodes. Results The overall rates of metastasis or recurrence in the upper, middle, and lower mediastinal lymph nodes were 4%, 7%, and 11%, respectively. Rates were significantly higher when the distance from the EGJ to the proximal edge of primary tumor was >3 cm for the upper and middle mediastinal nodes and >2 cm for the lower mediastinal nodes. Multivariate analysis revealed that this distance was the only factor significantly associated with metastasis or recurrence in any mediastinal region. The 5-year overall survival rate in the 12 patients with metastasis in the upper or middle mediastinal lymph nodes was 17%. Conclusion The distance from the EGJ to the proximal edge of primary tumor may be a significant indicator of metastasis or recurrence in the mediastinal lymph nodes in patients with Siewert type II tumors. Thorough mediastinal lymph node dissection via a transthoracic approach may provide a therapeutic benefit when the distance is >3 cm.

Original languageEnglish
Pages (from-to)551-555
Number of pages5
JournalSurgery (United States)
Volume157
Issue number3
DOIs
Publication statusPublished - 2015 Mar 1

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Esophagogastric Junction
Adenocarcinoma
Lymph Nodes
Neoplasm Metastasis
Recurrence
Neoplasms
Multivariate Analysis
Lymph Node Excision
Multicenter Studies
Dissection
Survival Rate

ASJC Scopus subject areas

  • Surgery
  • Medicine(all)

Cite this

Kurokawa, Y., Hiki, N., Yoshikawa, T., Kishi, K., Ito, Y., Ohi, M., ... Takeuchi, H. (2015). Mediastinal lymph node metastasis and recurrence in adenocarcinoma of the esophagogastric junction. Surgery (United States), 157(3), 551-555. https://doi.org/10.1016/j.surg.2014.08.099

Mediastinal lymph node metastasis and recurrence in adenocarcinoma of the esophagogastric junction. / Kurokawa, Yukinori; Hiki, Naoki; Yoshikawa, Takaki; Kishi, Kentaro; Ito, Yuichi; Ohi, Masaki; Wada, Noriko; Takiguchi, Shuji; Mine, Shinji; Hasegawa, Shinichi; Matsuda, Tatsuo; Takeuchi, Hiroya.

In: Surgery (United States), Vol. 157, No. 3, 01.03.2015, p. 551-555.

Research output: Contribution to journalArticle

Kurokawa, Y, Hiki, N, Yoshikawa, T, Kishi, K, Ito, Y, Ohi, M, Wada, N, Takiguchi, S, Mine, S, Hasegawa, S, Matsuda, T & Takeuchi, H 2015, 'Mediastinal lymph node metastasis and recurrence in adenocarcinoma of the esophagogastric junction', Surgery (United States), vol. 157, no. 3, pp. 551-555. https://doi.org/10.1016/j.surg.2014.08.099
Kurokawa, Yukinori ; Hiki, Naoki ; Yoshikawa, Takaki ; Kishi, Kentaro ; Ito, Yuichi ; Ohi, Masaki ; Wada, Noriko ; Takiguchi, Shuji ; Mine, Shinji ; Hasegawa, Shinichi ; Matsuda, Tatsuo ; Takeuchi, Hiroya. / Mediastinal lymph node metastasis and recurrence in adenocarcinoma of the esophagogastric junction. In: Surgery (United States). 2015 ; Vol. 157, No. 3. pp. 551-555.
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abstract = "Background Whether thorough mediastinal dissection is indicated in patients with Siewert type II adenocarcinoma of the esophagogastric junction (EGJ) remains controversial. We conducted a multicenter study to find a preoperative indicator of mediastinal node metastasis. Methods We retrospectively collected data on 315 patients with pT2-T4 Siewert type II tumors who underwent R0 or R1 resection. The rates of metastasis or recurrence were investigated for the upper, middle, and lower mediastinal lymph nodes. Multivariate logistic analysis was used to identify significant indicators of metastasis or recurrence in the mediastinal nodes. Results The overall rates of metastasis or recurrence in the upper, middle, and lower mediastinal lymph nodes were 4{\%}, 7{\%}, and 11{\%}, respectively. Rates were significantly higher when the distance from the EGJ to the proximal edge of primary tumor was >3 cm for the upper and middle mediastinal nodes and >2 cm for the lower mediastinal nodes. Multivariate analysis revealed that this distance was the only factor significantly associated with metastasis or recurrence in any mediastinal region. The 5-year overall survival rate in the 12 patients with metastasis in the upper or middle mediastinal lymph nodes was 17{\%}. Conclusion The distance from the EGJ to the proximal edge of primary tumor may be a significant indicator of metastasis or recurrence in the mediastinal lymph nodes in patients with Siewert type II tumors. Thorough mediastinal lymph node dissection via a transthoracic approach may provide a therapeutic benefit when the distance is >3 cm.",
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AU - Yoshikawa, Takaki

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AU - Ito, Yuichi

AU - Ohi, Masaki

AU - Wada, Noriko

AU - Takiguchi, Shuji

AU - Mine, Shinji

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AU - Matsuda, Tatsuo

AU - Takeuchi, Hiroya

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N2 - Background Whether thorough mediastinal dissection is indicated in patients with Siewert type II adenocarcinoma of the esophagogastric junction (EGJ) remains controversial. We conducted a multicenter study to find a preoperative indicator of mediastinal node metastasis. Methods We retrospectively collected data on 315 patients with pT2-T4 Siewert type II tumors who underwent R0 or R1 resection. The rates of metastasis or recurrence were investigated for the upper, middle, and lower mediastinal lymph nodes. Multivariate logistic analysis was used to identify significant indicators of metastasis or recurrence in the mediastinal nodes. Results The overall rates of metastasis or recurrence in the upper, middle, and lower mediastinal lymph nodes were 4%, 7%, and 11%, respectively. Rates were significantly higher when the distance from the EGJ to the proximal edge of primary tumor was >3 cm for the upper and middle mediastinal nodes and >2 cm for the lower mediastinal nodes. Multivariate analysis revealed that this distance was the only factor significantly associated with metastasis or recurrence in any mediastinal region. The 5-year overall survival rate in the 12 patients with metastasis in the upper or middle mediastinal lymph nodes was 17%. Conclusion The distance from the EGJ to the proximal edge of primary tumor may be a significant indicator of metastasis or recurrence in the mediastinal lymph nodes in patients with Siewert type II tumors. Thorough mediastinal lymph node dissection via a transthoracic approach may provide a therapeutic benefit when the distance is >3 cm.

AB - Background Whether thorough mediastinal dissection is indicated in patients with Siewert type II adenocarcinoma of the esophagogastric junction (EGJ) remains controversial. We conducted a multicenter study to find a preoperative indicator of mediastinal node metastasis. Methods We retrospectively collected data on 315 patients with pT2-T4 Siewert type II tumors who underwent R0 or R1 resection. The rates of metastasis or recurrence were investigated for the upper, middle, and lower mediastinal lymph nodes. Multivariate logistic analysis was used to identify significant indicators of metastasis or recurrence in the mediastinal nodes. Results The overall rates of metastasis or recurrence in the upper, middle, and lower mediastinal lymph nodes were 4%, 7%, and 11%, respectively. Rates were significantly higher when the distance from the EGJ to the proximal edge of primary tumor was >3 cm for the upper and middle mediastinal nodes and >2 cm for the lower mediastinal nodes. Multivariate analysis revealed that this distance was the only factor significantly associated with metastasis or recurrence in any mediastinal region. The 5-year overall survival rate in the 12 patients with metastasis in the upper or middle mediastinal lymph nodes was 17%. Conclusion The distance from the EGJ to the proximal edge of primary tumor may be a significant indicator of metastasis or recurrence in the mediastinal lymph nodes in patients with Siewert type II tumors. Thorough mediastinal lymph node dissection via a transthoracic approach may provide a therapeutic benefit when the distance is >3 cm.

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