Appropriate extent of lymphadenectomy for squamous cell carcinoma of the esophagogastric junction. (August 2017)

• Record Type: Journal Article
• Authors: Kosugi, Shin-ichi; Ichikawa, Hiroshi; Hanyu, Takaaki; Ishikawa, Takashi; Wakai, Toshifumi
• Is Part Of: International journal of surgery. Volume 44(2017)
• Page Start: 339
• Page End: 343
• Publication Date: 2017-08
• Subjects: Squamous cell carcinoma -- Esophagogastric junction -- Lymph node metastasis -- Lymphadenectomy -- Survival -- Therapeutic value; Surgery -- Periodicals; Surgical Procedures, Operative -- Periodicals; 617.005
• DOI: 10.1016/j.ijsu.2017.07.041
• Languages: English
• ISSNs: 1743-9191

Abstract

Abstract: Aim: To investigate the appropriate extent of lymphadenectomy for squamous cell carcinoma (SCC) of the esophagogastric junction (ECJ). Methods: We retrospectively reviewed the cases of 52 patients with SCC of the ECJ who underwent extended mediastinal lymphadenectomy. We assessed potential risk factors for lymph node metastasis (LNM) in the upper/middle mediastinum by conducting univariate and multivariate analyses, and a receiver operating characteristic (ROC) curve analysis was used to evaluate the predictive value. Survival rates were calculated using the Kaplan-Meier method, and the therapeutic value index of each nodal basin dissection was calculated by multiplying the frequency of metastasis at the basin and the 5-year overall survival rate of patients with metastasis at that basin. Results: Twenty patients (38%) had mediastinal LNM; 13 (25%) had metastasis in the upper/middle mediastinum, and 13 (25%) had metastasis in the lower mediastinum. Tumor length ( P = 0.03) and pathological nodal status ( P = 0.01) were independent risk factors for upper/middle mediastinal LNM. The optimal ROC cutoff value of tumor length was 54 mm. The 5-year overall survival rate of the patients with LNM in the upper/middle mediastinum was 46%. The therapeutic value index of upper/middle mediastinal lymphadenectomy was 11.6, which was inferior to that of perigastric lymphadenectomy at 17.3, but superior to that of lower mediastinal lymphadenectomy at 5.8. Conclusion: An upper/middle mediastinal lymphadenectomy may be required for patients with tumors that are ≥54 mm long, and in those with suspected LNM. Highlights: Metastasis in the upper/middle mediastinal nodes: seen in 25% of ECJ SCC patients. Tumor length was an independent risk factor, with the cutoff value of 54 mm. The therapeutic value of upper/middle mediastinal lymphadenectomy was high. Extended mediastinal lymphadenectomy may be required for patients at risk.