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. 2016 May;95(21):e3473.
doi: 10.1097/MD.0000000000003473.

Should Splenic Hilar Lymph Nodes be Dissected for Siewert Type II and III Esophagogastric Junction Carcinoma Based on Tumor Diameter?: A Retrospective Database Analysis

Chen-Bin Lv  1 , Chang-Ming Huang, Chao-Hui Zheng, Ping Li, Jian-Wei Xie, Jia-Bin Wang, Jian-Xian Lin, Jun Lu, Qi-Yue Chen, Long-Long Cao, Mi Lin, Ru-Hong Tu
Affiliations

Should Splenic Hilar Lymph Nodes be Dissected for Siewert Type II and III Esophagogastric Junction Carcinoma Based on Tumor Diameter?: A Retrospective Database Analysis

Chen-Bin Lv et al. Medicine (Baltimore). 2016 May.

Abstract

The aim of the study is to identify the value of a spleen-preserving No. 10 lymphadenectomy (SPL) for Siewert type II/III adenocarcinoma of the esophagogastric junction (AEG).From January 2007 to June 2014, 694 patients undergoing radical total gastrectomy for Siewert type II/III AEG were analyzed. Oncologic outcomes were compared between SPL and no SPL (No. 10D+ and No. 10D-) groups.The incidence of No. 10 lymph node metastasis (LNM) was 12.3%. No significant differences in the incidence of No. 10 LNM were found between Siewert type II AEG with tumor diameters of <4 cm and ≥4 cm (P = 0.071). However, Siewert type III AEG with a tumor diameter ≥4 cm showed a significantly higher frequency of No. 10 LNM compared with a tumor diameter <4 cm (P < 0.001). The No. 10D+ group had superior 3-year overall survival (OS) and disease-free survival (DFS) rates compared with the No. 10D- group (P = 0.030 and P = 0.005, respectively). For patients with Siewert type II and type III AEG with a tumor diameter <4 cm, the 3-year OS and DFS rates were similar between the 2 groups. However, the No. 10D+ group had better 3-year OS (66.6% vs 51.1%, P = 0.019) and DFS (63.2% vs 45.9%, P = 0.007) rates for Siewert type III AEG with a tumor diameter ≥4 cm. A multivariate Cox regression showed that SPL was an independent prognostic factor in Siewert type III AEG with a tumor diameter ≥4 cm.SPL may improve the prognosis of Siewert type III AEG with a tumor diameter ≥4 cm, whereas SPL may be omitted without decreasing survival in patients with Siewert type II or type III AEG with a tumor diameter <4 cm.

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Conflict of interest statement

The authors have no conflicts of interest to disclose.

Figures

FIGURE 1
FIGURE 1
Incidence of No. 10 LNM in the No. 10D+ group.
FIGURE 2
FIGURE 2
Comparison of the overall and disease-free survival rates between the No. 10D+ and No. 10D– groups: (A) overall survival outcomes and (B) disease-free survival outcomes.
FIGURE 3
FIGURE 3
Comparison of the overall and disease-free survival rates of Siewert type III AEG between the No. 10D+ and No. 10D– groups: (A) overall survival outcomes and (B) disease-free survival outcomes. AEG = adenocarcinoma of the oesophagogastric junction.
FIGURE 4
FIGURE 4
Comparison of the overall and disease-free survival rates of Siewert type III AEG with a tumor diameter ≥4 cm between the No. 10D+ and No. 10D– groups: (A) overall survival outcomes and (B) disease-free survival outcomes. AEG = adenocarcinoma of the oesophagogastric junction.
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