Tatsuo Matsuda1,2, Yukinori Kurokawa3, Takaki Yoshikawa4, Kentaro Kishi5, Kazunari Misawa6, Masaki Ohi7, Shinji Mine2, Naoki Hiki8, Hiroya Takeuchi9. 1. Department of Surgery, Keio University School of Medicine, 35 Shinanomachi, Shinjuku-ku, Tokyo, 160-8582, Japan. 2. Department of Gastroenterological Surgery, Cancer Institute Hospital, Japanese Foundation for Cancer Research, 3-10-6 Ariake, Koto-ku, Tokyo, 135-8550, Japan. 3. Department of Gastroenterological Surgery, Osaka University Graduate School of Medicine, 2-2 Yamadaoka Suita, Osaka, 565-0871, Japan. 4. Department of Surgery, Kanagawa Cancer Center, 2-3-2 Nakao, Asahi, Yokohama, Kanagawa, 241-0815, Japan. 5. Department of Surgery, Osaka Medical Center for Cancer and Cardiovascular Diseases, 3-3 Nakamichi 1-Chome, Higashinari-ku, Osaka, 537-8511, Japan. 6. Department of Gastroenterological Surgery, Aichi Cancer Center Hospital, 1-1 Kanokoden, Chikusa-ku, Nagoya, 464-8681, Japan. 7. Department of Surgery, Mie University Graduate School of Medicine, 2-174 Edobashi Tsu, Mie, 514-8507, Japan. 8. Department of Gastroenterological Surgery, Cancer Institute Hospital, Japanese Foundation for Cancer Research, 3-10-6 Ariake, Koto-ku, Tokyo, 135-8550, Japan. naoki.hiki@jfcr.or.jp. 9. Department of Surgery, Keio University School of Medicine, 35 Shinanomachi, Shinjuku-ku, Tokyo, 160-8582, Japan. htakeuchi@a6.keio.jp.
Abstract
BACKGROUND: The incidence of esophagogastric junction (EGJ) carcinoma is increasing, but its optimal surgical management remains controversial. METHODS: We retrospectively reviewed the database of 400 patients with Siewert type II EGJ carcinoma who were treated surgically at 7 institutions between March 1986 and October 2010. We examined the clinicopathological characteristics, prognostic factors, and risk factors associated with each recurrence pattern. RESULTS: The 5-year overall survival rate of all patients with Siewert type II EGJ carcinoma was 58.4 %. Multivariate analysis showed that T and N stages were independent prognostic factors. We also found that the incidence of lower mediastinal lymph node metastasis (17.7 %) and para-aortic lymph node metastasis (16.1 %) was relatively high. In addition, the para-aortic lymph nodes (N = 39, 9.8 %) were the most frequent node recurrence site, followed by the mediastinal lymph nodes (N = 23, 5.8 %). Lung recurrence was more common than was peritoneal recurrence. Considering each type of recurrence, multivariate analysis showed that the differentiated type was associated with a higher risk of lung recurrence than was the undifferentiated type, and N stage (pN2-3) and positive venous invasion were independent risk factors for liver recurrence. CONCLUSIONS: This study is one of the largest retrospective studies to evaluate patients with Siewert type II EGJ carcinoma. Para-aortic and mediastinal lymph node metastasis and recurrence rates were relatively high. During the postoperative follow-up of patients with differentiated Siewert type II EGJ carcinoma, patients should be monitored for lung recurrence more closely than that for peritoneal recurrence.
BACKGROUND: The incidence of esophagogastric junction (EGJ) carcinoma is increasing, but its optimal surgical management remains controversial. METHODS: We retrospectively reviewed the database of 400 patients with Siewert type II EGJ carcinoma who were treated surgically at 7 institutions between March 1986 and October 2010. We examined the clinicopathological characteristics, prognostic factors, and risk factors associated with each recurrence pattern. RESULTS: The 5-year overall survival rate of all patients with Siewert type II EGJ carcinoma was 58.4 %. Multivariate analysis showed that T and N stages were independent prognostic factors. We also found that the incidence of lower mediastinal lymph node metastasis (17.7 %) and para-aortic lymph node metastasis (16.1 %) was relatively high. In addition, the para-aortic lymph nodes (N = 39, 9.8 %) were the most frequent node recurrence site, followed by the mediastinal lymph nodes (N = 23, 5.8 %). Lung recurrence was more common than was peritoneal recurrence. Considering each type of recurrence, multivariate analysis showed that the differentiated type was associated with a higher risk of lung recurrence than was the undifferentiated type, and N stage (pN2-3) and positive venous invasion were independent risk factors for liver recurrence. CONCLUSIONS: This study is one of the largest retrospective studies to evaluate patients with Siewert type II EGJ carcinoma. Para-aortic and mediastinal lymph node metastasis and recurrence rates were relatively high. During the postoperative follow-up of patients with differentiated Siewert type II EGJ carcinoma, patients should be monitored for lung recurrence more closely than that for peritoneal recurrence.
Authors: Andrew M Brown; Danica N Giugliano; Adam C Berger; Michael J Pucci; Francesco Palazzo Journal: Langenbecks Arch Surg Date: 2017-08-12 Impact factor: 3.445