M. Yura1, H. Takeuchi1, R. Nakamura1, T. Takahashi1, N. Wada1, H. Kawakubo1, Y. Kitagawa1 1Keio University, School Of Medicine,Department Of Surgery,Shinjuku-ku, TOKYO, Japan
Introduction: Incidence of esophagogastric junction carcinoma is increasing worldwide. However, surgical strategies for this cancer remain controversial. This study aimed to clarify the optimal surgical strategy for EGJ adenocarcinoma.
Methods: We retrospectively reviewed a data base of 87 consecutive patients with EGJ adenocarcinoma who underwent curative surgical resection at Keio University Hospital between January 2000 and December 2013. EGJ carcinoma defined as Siewert’s classification ?Siewert type I, N=11 (13%); Siewert type II, N=68 (78%); Siewert type III, N=8 (9%)?
Results: Of 87 patients, 33 (37%) were pT1 and 54 (63%) were pT2≤. Mediastinal lymph node (MLN) metastasis was observed in 9 patients. Patients with pT2≤ had a higher incidence of mediastinal lymph node MLN metastasis as compared with patients with pT1 (14.8% in pT2≤ and 3.0% in pT1). In the patients with pT1, lower MLN metastasis ?was identified with Siewert type I (1/6; 17%) and not identified with Siewert type II (0/25; 0%). Upper/middle MLN metastasis was observed in four cases with pT2≤?Siewert type I, N=3 (60%); Siewert type II, N=1 (12%); Siewert type III, N=0 (0%)?. Of all patients having pT2≤ carcinoma with the tumor center located below EGJ (N=36), no patients exhibited upper/middle MLN metastasis and one patient (2.7%) had lower MLN metastasis. In the patients with pT2≤ carcinoma that tumor center was located above EGJ (N=18), upper/middle MLN metastasis was observed in three patients (16.7%) and lower MLN metastasis was observed in five patients (27.8%). The transthoracic approach was used in all patients with Siewert type I and 12 patients (17.6%) with Siewert type II. The transabdominal approach was used in the patients with Siewert type II/III ?Siewert type II, N=56 (82%), Siewert type III, N=8 (100%)?.
Conclusion: In the patients with superficial Siewert type II carcinoma, necessity of mediastinal LN resection is very low. For those patients, laparoscopy-assisted proximal gastrectomy may be a minimally invasive surgical technique. MLN lymph node dissection through transthoracic approach seems unnecessary, particularly if the tumor center is located below EGJ.