Skip to main content
Key Specialties
Cardiology Diabetology Endocrinology Gastroenterology Geriatrics and Gerontology Gynecology and Obstetrics Hematology Infectious Disease Internal Medicine Nephrology Neurology Oncology Pediatrics Respiratory Medicine Rheumatology Surgery
Congress Coverage
2024 ACC Congress 2023 ESMO Congress 2023 EASD Congress 2023 ERS Congress 2023 ESC Congress
Clinical Collections
Advances in Alzheimer’s

Keynote webinar | Spotlight on medication adherence

LIVE: Thursday 27th June 2024, 18:00-19:30 (CEST)
Join our expert panel to discover why you need to understand the drivers of non-adherence in your patients, and how you can optimize medication adherence in your clinics to drastically improve patient outcomes.
ADVANCED SEARCH
Log in
Top
Annals of Surgical Oncology
Published in: Annals of Surgical Oncology 5/2014

01-05-2014 | Breast Oncology

Thoracic Lymph Node Involvement in Adenocarcinoma of the Esophagogastric Junction and Lower Esophageal Squamous Cell Carcinoma Relative to the Location of the Proximal End of the Tumor

Authors: Shinji Mine, MD, Takeshi Sano, MD, PhD, Naoki Hiki, MD, PhD, Kazuhiko Yamada, MD, PhD, Toshiyuki Kosuga, MD, Souya Nunobe, MD, PhD, Hironobu Shigaki, MD, PhD, Toshiharu Yamaguchi, MD, PhD

Published in: Annals of Surgical Oncology | Issue 5/2014

Login to get access

Abstract

Background

It is difficult to determine preoperatively whether upper/middle thoracic lymphadenectomy is necessary in patients with adenocarcinoma of the esophagogastric junction (AEG) or lower esophageal squamous cell carcinoma (ESCC). Here, we investigated whether stratification based on the location of the proximal end of the tumor, as assessed using preoperative computed tomography (CT) images, would be useful for predicting upper/middle thoracic lymph node involvement for AEG and lower ESCC.

Methods

A total of 142 patients with AEG and lower ESCC treated by R0–1 surgical resection via a thoracotomy was retrospectively investigated. The location of the proximal end of the tumor in comparison with the vena cava foramen (VCF) was decided by inspecting preoperative CT images and then correlated with upper/middle thoracic lymph node involvement.

Results

The incidence of upper/middle thoracic lymph node involvement was low in AEG and ESCC tumors having proximal ends below the VCF (0 %, 0 of 13, and 5.9 %, 1 of 17, for AEG and ESCC, respectively). In contrast, when the tumors’ proximal ends were above the VCF, patients had higher frequencies of upper/middle thoracic lymph node involvement (36.4 %, 8 of 22, and 37.8 %, 34 of 90, for AEG and ESCC, respectively). Multivariate analysis showed that the location of the proximal end of the tumor is an independent risk factor related to upper/middle thoracic lymph node involvement (odds ratio 14.3, 95 % confidence interval 1.76–111, p = 0.013), whereas other clinical factors (cT, cN, tumor length, and histologic types) are not.

Conclusions

This manner of stratification using preoperative CT images could be useful in deciding the extent of thoracic lymphadenectomy in both AEG and ESCC.
Literature
1.
Devesa SS, Blot WJ, Fraumeni JF Jr. Changing patterns in the incidence of esophageal and gastric carcinoma in the United States. Cancer. 1998;83:2049–53.PubMedCrossRef
2.
Dolan K, Sutton R, Walker SJ, Morris AI, Campbell F, Williams EM. New classification of oesophageal and gastric carcinomas derived from changing patterns in epidemiology. Br J Cancer. 1999;80:834–42.PubMedCentralPubMedCrossRef
3.
DeMeester SR. Adenocarcinoma of the esophagus and cardia: a review of the disease and its treatment. Ann Surg Oncol. 2006;13:12–30.PubMedCrossRef
4.
Hulscher JB, van Sandick JW, de Boer AG, et al. Extended transthoracic resection compared with limited transhiatal resection for adenocarcinoma of the esophagus. N Engl J Med. 2002;347:1662–9.PubMedCrossRef
5.
Lerut T, Decker G, Coosemans W, et al. Quality indicators of surgery for adenocarcinoma of the esophagus and gastroesophageal junction. Recent Results Cancer Res. 2010;182:127–42.PubMedCrossRef
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;7:644–51.PubMedCrossRef
7.
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;246:1–8.PubMedCentralPubMedCrossRef
8.
Schiesser M, Schneider PM. Surgical strategies for adenocarcinoma of the esophagogastric junction. Recent Results Cancer Res. 2010;182:93–106.PubMedCrossRef
9.
Leers JM, DeMeester SR, Chan N, et al. Clinical characteristics, biologic behavior, and survival after esophagectomy are similar for adenocarcinoma of the gastroesophageal junction and the distal esophagus. J Thorac Cardiovasc Surg. 2009;138:594–602; discussion 601–2.PubMedCrossRef
10.
Powell J, McConkey CC, Gillison EW, Spychal RT. Continuing rising trend in oesophageal adenocarcinoma. Int J Cancer. 2002;102:422–7.PubMedCrossRef
11.
Powell J, McConkey CC. The rising trend in oesophageal adenocarcinoma and gastric cardia. Eur J Cancer Prev. 1992;1:265–9.PubMedCrossRef
12.
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.PubMedCentralPubMedCrossRef
13.
Kakeji Y, Yamamoto M, Ito S, et al. Lymph node metastasis from cancer of the esophagogastric junction, and determination of the appropriate nodal dissection. Surg Today. 2012;42:351–8.PubMedCrossRef
14.
Siewert JR, Stein HJ. Classification of adenocarcinoma of the oesophagogastric junction. Br J Surg. 1998;85:1457–9.PubMedCrossRef
15.
Grotenhuis BA, Wijnhoven BP, Poley JW, et al. Preoperative assessment of tumor location and station-specific lymph node status in patients with adenocarcinoma of the gastroesophageal junction. World J Surg. 2013;37:147–55.PubMedCrossRef
16.
Akiyama H, Miyazono H, Tsurumaru M, Hashimoto C, Kawamura T. Thoracoabdominal approach for carcinoma of the cardia of the stomach. Am J Surg. 1979;137:345–9.PubMedCrossRef
17.
Matsubara T, Ueda M, Nagao N, Takahashi T, Nakajima T, Nishi M. Cervicothoracic approach for total mesoesophageal dissection in cancer of the thoracic esophagus. J Am Coll Surg. 1998;187:238–45.PubMedCrossRef
18.
Matsubara T, Ueda M, Nagao N, Takahashi T, Nakajima T, Nishi M. Surgical treatment for carcinoma of the thoracic esophagus with major involvement in the neck or upper mediastinum. J Surg Oncol. 1998;67:6–10.PubMedCrossRef
19.
Matsubara T, Ueda M, Yanagida O, Nakajima T, Nishi M. How extensive should lymph node dissection be for cancer of the thoracic esophagus? J Thorac Cardiovasc Surg. 1994;107:1073–8.PubMed
20.
Sobin L, Gospodarowicz M, Wittekind C. TNM classification of malignant tumours. 7th ed. New York: Wiley-Blackwell; 2009.
21.
Omloo JM, Lagarde SM, Hulscher JB, et al. 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. 2007;246:992–1000; discussion 1000–1.PubMedCrossRef
22.
Lerut T, Nafteux P, Moons J, et al. Three-field lymphadenectomy for carcinoma of the esophagus and gastroesophageal junction in 174 R0 resections: impact on staging, disease-free survival, and outcome—a plea for adaptation of TNM classification in upper-half esophageal carcinoma. Ann Surg. 2004;240:962–72; discussion 972–4.PubMedCentralPubMedCrossRef
23.
Altorki N, Kent M, Ferrara C, Port J. Three-field lymph node dissection for squamous cell and adenocarcinoma of the esophagus. Ann Surg. 2002;236:177–83.PubMedCentralPubMedCrossRef
24.
Ginsberg RJ, Rubinstein LV. Randomized trial of lobectomy versus limited resection for T1 N0 non-small cell lung cancer. Lung Cancer Study Group. Ann Thorac Surg. 1995;60:615–22; discussion 622–13.PubMedCrossRef
Metadata
Title
Thoracic Lymph Node Involvement in Adenocarcinoma of the Esophagogastric Junction and Lower Esophageal Squamous Cell Carcinoma Relative to the Location of the Proximal End of the Tumor
Authors
Shinji Mine, MD
Takeshi Sano, MD, PhD
Naoki Hiki, MD, PhD
Kazuhiko Yamada, MD, PhD
Toshiyuki Kosuga, MD
Souya Nunobe, MD, PhD
Hironobu Shigaki, MD, PhD
Toshiharu Yamaguchi, MD, PhD
Publication date
01-05-2014
Publisher
Springer US
Published in
Annals of Surgical Oncology / Issue 5/2014
Print ISSN: 1068-9265
Electronic ISSN: 1534-4681
DOI
https://doi.org/10.1245/s10434-014-3548-2

Other articles of this Issue 5/2014

Annals of Surgical Oncology 5/2014 Go to the issue

Erratum

Erratum to: Extended Neoadjuvant Chemotherapy for Borderline Resectable Pancreatic Cancer Demonstrates Promising Postoperative Outcomes and Survival

Breast Oncology

Magnetic Resonance Imaging in Patients with Ductal Carcinoma in Situ: Routine, Selective, or not at all?

Melanomas

The Role of Sentinel Lymph Node Biopsy in Patients with Merkel Cell Carcinoma: Uncertainty Prevails

Melanomas

Sentinel Lymph Node Biopsy is Associated with Improved Survival in Merkel Cell Carcinoma

Original Article -– Regional Cancer Therapies

Safety of Epidural Analgesia in the Perioperative Care of Patients Undergoing Cytoreductive Surgery with Hyperthermic Intraperitoneal Chemotherapy

Pancreatic Tumors

Comparison of Preoperative Conference-Based Diagnosis with Histology of Cystic Tumors of the Pancreas