Impact of lower mediastinal lymphadenectomy for the treatment of esophagogastric junction carcinoma

Abstract

Aim: To define the optimal extent of resection for esophagogastric junction (EGJ) carcinoma.

Patients and methods: We retrospectively reviewed medical records of 193 patients with EGJ adenocarcinoma or squamous cell carcinoma who underwent surgery at the Kitasato University. An index was calculated to evaluate the therapeutic value of lymphadenectomy.

Results: The following factors were identified as independent predictors of poor survival: (y)pT3-4, (y)pN3, ly2-3, no performance of splenectomy and R1-2. Although metastases were found in mediastinal lymph-nodes in patients with esophageal invasion of ≤30 mm, the index was 0 for all mediastinal lymph-nodes. By contrast, in patients with esophageal invasion of >30 mm, the index was 13.9 for the No. 110 nodes, which was the second highest after the index for the No. 1 nodes.

Conclusion: In EGJ cancer patients with esophageal invasion of >30 mm, aggressive lower mediastinal lymphadenectomy with R0 resection is required to obtain the best result.

Keywords: Esophagogastric junction; lymph node excision; neoplasms; prognosis; surgery.