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Annals of Surgical Oncology
Published in: Annals of Surgical Oncology 12/2017

01-11-2017 | Gastrointestinal Oncology

Recurrence Pattern and Lymph Node Metastasis of Adenocarcinoma at the Esophagogastric Junction

Authors: Yun-Suhk Suh, MD, Kyung-Goo Lee, MD, Seung-Young Oh, MD, Seong-Ho Kong, MD, Hyuk-Joon Lee, MD, Woo-Ho Kim, MD, Han-Kwang Yang, MD

Published in: Annals of Surgical Oncology | Issue 12/2017

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Abstract

Background

The surgical approach for adenocarcinoma of the esophagogastric junction (AEJ) still is controversial despite revised tumor-node-metastasis (TNM) classification. This study aimed to evaluate the oncologic outcome of a routine transhiatal approach for AEJ in terms of recurrence and lymph node (LN) metastasis of AEJ.

Methods

Recurrence patterns and LN metastasis of a single, primary AEJ (n = 463) treated by a surgical resection using a transhiatal approach without routine complete mediastinal LN dissection or routine splenectomy were analyzed respectively. To validate current treatment for recurrence, a validation index of recurrence (ViR; overall survival/incidence of solitary recurrence factor) was developed.

Results

The overall recurrence rate for AEJ was 20.3%, which did not differ significantly between AEJ II (20.8%; n = 125) and AEJ III (20.1%; n = 338). Mediastinal recurrence did not differ significantly among the subtypes of AEJ, irrespective of gastroesophageal junction involvement. Splenic hilar LN recurrence-free survival did not differ significantly between the gastrectomy-only group, the gastrectomy-plus-splenectomy group, and the gastrectomy plus distal pancreatectomy group. The solitary recurrence rate for the mediastinal LN was 0.7% for AEJ, and the overall median survival with that recurrence was 30.5 months. The ViR for mediastinal LN recurrence (43.6) was higher than for regional LN (20.9) or distant LN (14.6) metastasis.

Conclusion

In terms of LN metastasis and recurrence, a transhiatal approach without complete mediastinal LN dissection can be acceptable, and routine splenectomy is not necessary for AEJ II or AEJ III arising within the stomach.
Appendix
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Literature
1.
Siewert JR, Holscher AH, Becker K, Gossner W. Cardia cancer: attempt at a therapeutically relevant classification. Chirurg. 1987;58:25–32.PubMed
2.
Kodera Y, Yamamura Y, Shimizu Y, et al. Adenocarcinoma of the gastroesophageal junction in Japan: relevance of Siewert’s classification applied to 177 cases resected at a single institution. J Am Coll Surg. 1999;189:594–601.CrossRefPubMed
3.
Siewert J, Feith M, Werner M, Stein H. Adenocarcinoma of the esophagogastric junction: results of surgical therapy based on anatomical/topographic classification in 1,002 consecutive patients. Ann Surg. 2000;232:353–61.CrossRef
4.
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;90:139–46; discussion 146.
5.
Nakamura T, Ide H, Eguchi R, Ota M, Shimizu S, Isono K. Adenocarcinoma of the esophagogastric junction: a summary of responses to a questionnaire on adenocarcinoma of the esophagus and the esophagogastric junction in Japan. Dis Esophagus. 2002;15:219–25.CrossRefPubMed
6.
Edge S, Byrd D, Carducci M, Compton C. AJCC Cancer Staging Manual. Springer, New York, NY, 2009.
7.
Huang Q, Shi J, Feng A, et al. Gastric cardiac carcinomas involving the esophagus are more adequately staged as gastric cancers by the 7th edition of the American Joint Commission on Cancer Staging System. Mod Pathol. 2011;24:138–46.
8.
Gertler R, Stein HJ, Schuster T, Rondak IC, Hofler H, Feith M. Prevalence and topography of lymph node metastases in early esophageal and gastric cancer. Ann Surg. 2014;259:96–101.CrossRefPubMed
9.
Hasegawa S, Yoshikawa T, Aoyama T, et al. Esophagus or stomach? The seventh TNM classification for Siewert type II/III junctional adenocarcinoma. Ann Surg Oncol. 2013;20:773–9.CrossRefPubMed
10.
Suh YS, Han DS, Kong SH, et al. Should adenocarcinoma of the esophagogastric junction be classified as esophageal cancer? A comparative analysis according to the seventh AJCC TNM classification. Ann Surg. 2012;255:908–15.CrossRefPubMed
11.
Suh YS, Kong SH, Lee HJ, Yang HK. Reply to letter: “Should Adenocarcinoma of the Esophagogastric Junction Be Classified as Esophageal Cancer? Limited to Siewert Type II, Yes.” Ann Surg. 2015;261:e67–8.CrossRefPubMed
12.
Suh YS, Kong SH, Lee HJ, Yang HK. Reply to the letter: “Should Adenocarcinoma of the Esophagogastric Junction Be Classified as Gastric or Esophageal Cancer, or Else as a Distinct Clinical Entity?” Ann Surg. 2016;264:e5–6.CrossRefPubMed
13.
Yamashita H, Katai H, Morita S, Saka M, Taniguchi H, Fukagawa T. Optimal extent of lymph node dissection for Siewert type II esophagogastric junction carcinoma. Ann Surg. 2011;254:274–80.CrossRefPubMed
14.
Peng J, Wang WP, Yuan Y, Hu Y, Wang Y, Chen LQ. Optimal extent of lymph node dissection for siewert type II esophagogastric junction adenocarcinoma. Ann Thorac Surg. 2015;100:263–9.CrossRefPubMed
15.
Mine S, Sano T, Hiki N, Yamada K, Nunobe S, Yamaguchi T. Lymphadenectomy around the left renal vein in Siewert type II adenocarcinoma of the oesophagogastric junction. Br J Surg. 2013;100:261–6.CrossRefPubMed
16.
Japanese Gastric Cancer Association. Japanese gastric cancer treatment guidelines 2014 (version 4). Gastric Cancer. 2017;20:1–19.CrossRef
17.
Hosokawa Y, Kinoshita T, Konishi M, et al. 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. 2012;19:677–83.CrossRefPubMed
18.
Hosoda K, Yamashita K, Katada N, et al. Impact of lower mediastinal lymphadenectomy for the treatment of esophagogastric junction carcinoma. Anticancer Res. 2015;35:445–56.PubMed
19.
Kurokawa Y, Hiki N, Yoshikawa T, et al. Mediastinal lymph node metastasis and recurrence in adenocarcinoma of the esophagogastric junction. Surgery. 2015;157:551–5.CrossRefPubMed
20.
Yu W, Choi G, Chung H. Randomized clinical trial of splenectomy versus splenic preservation in patients with proximal gastric cancer. Br J Surg. 2006;93:559–63.CrossRefPubMed
21.
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.CrossRefPubMed
22.
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.CrossRefPubMed
23.
Japanese Gastric Cancer Association. Japanese gastric cancer treatment guidelines 2010 (version 3). Gastric Cancer. 2011;14:113–23.CrossRef
24.
Bosman FT, Carneiro F, Hruban RH, Theise ND WHO classification of tumours of the digestive system. World Health Organization, Geneva, 2010.
25.
Ahn HS, Lee HJ, Hahn S, et al. Evaluation of the seventh American Joint Committee on Cancer/International Union Against Cancer Classification of gastric adenocarcinoma in comparison with the sixth classification. Cancer. 2010;116:5592–8.CrossRefPubMed
26.
Sano T, Sasako M, Mizusawa J, et al. Randomized controlled trial to evaluate splenectomy in total gastrectomy for proximal gastric carcinoma. Ann Surg. 2017;265:277–83.CrossRefPubMed
27.
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.CrossRefPubMedPubMedCentral
28.
Mine S, Sano T, Hiki N, et al. Proximal margin length with transhiatal gastrectomy for Siewert type II and III adenocarcinomas of the oesophagogastric junction. Br J Surg. 2013;100:1050–4.CrossRefPubMed
29.
Rice TW, Ishwaran H, Ferguson MK, Blackstone EH, Goldstraw P. Cancer of the esophagus and esophagogastric junction: an eighth-edition staging primer. J Thorac Oncol. 2017;12:36–42.CrossRefPubMed
30.
Okabayashi T, Gotoda T, Kondo H, et al. Early carcinoma of the gastric cardia in Japan: is it different from that in the West? Cancer. 2000;89:2555–9.CrossRefPubMed
31.
Hasegawa S, Yoshikawa T, Cho H, Tsuburaya A, Kobayashi O. Is adenocarcinoma of the esophagogastric junction different between Japan and Western countries? The incidence and clinicopathological features at a japanese high-volume cancer center. World J Surg. 2009;33:95–103.CrossRefPubMed
32.
Suh YS, Yang HK. Screening and early detection of gastric cancer: East versus West. Surg Clin North Am. 2015;95:1053–66.CrossRefPubMed
Metadata
Title
Recurrence Pattern and Lymph Node Metastasis of Adenocarcinoma at the Esophagogastric Junction
Authors
Yun-Suhk Suh, MD
Kyung-Goo Lee, MD
Seung-Young Oh, MD
Seong-Ho Kong, MD
Hyuk-Joon Lee, MD
Woo-Ho Kim, MD
Han-Kwang Yang, MD
Publication date
01-11-2017
Publisher
Springer International Publishing
Published in
Annals of Surgical Oncology / Issue 12/2017
Print ISSN: 1068-9265
Electronic ISSN: 1534-4681
DOI
https://doi.org/10.1245/s10434-017-6011-3

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