scholarly journals Is the length of esophageal invasion only associated with mediastinal nodal metastasis from adenocarcinoma of the esophagogastric junction (Siewert type II and III) after neo-adjuvant chemoradiotherapy?

2019 ◽  
Vol 11 (10) ◽  
pp. E152-E153
Author(s):  
Shinji Mine
Keyword(s):  
Esophagogastric Junction ◽  
Nodal Metastasis ◽  
Adjuvant Chemoradiotherapy ◽  
Type Ii ◽  
Siewert Type ◽  
Siewert Type Ii ◽  
Esophageal Invasion

scholarly journals Proximal Gastrectomy versus Total Gastrectomy for Siewert Type II Adenocarcinoma of the Esophagogastric Junction: A Comprehensive Analysis of Data from the SEER Registry

2019 ◽  
Vol 2019 ◽  
pp. 1-11 ◽  
Author(s):  
Kaixuan Zhu ◽  
Yingying Xu ◽  
Jiaxin Fu ◽  
Farah Abdidahir Mohamud ◽  
Zongkui Duan ◽  
...  
Keyword(s):  
Total Gastrectomy ◽  
Surgical Approach ◽  
Esophagogastric Junction ◽  
Proximal Gastrectomy ◽  
Locally Advanced ◽  
Cox Proportional Hazards Model ◽  
Type Ii ◽  
Siewert Type ◽  
Siewert Type Ii ◽  
Significant Difference

Background. To determine the ideal surgical approach (total gastrectomy (TG) vs. proximal gastrectomy (PG)) for Siewert type II adenocarcinoma of the esophagogastric junction (AEG), we searched and analyzed the Surveillance, Epidemiology, and End Results (SEER) data. Methods. Patients with Siewert type II AEG treated by TG or PG were identified from the 2004–2014 SEER dataset. We obtained the patients’ overall survival (OS) and cancer-specific survival (CSS) and stratified the patients by surgical approach. We performed a propensity score 1 : 1 matching (PSM) analysis and a univariate and multivariate Cox proportional hazards model. Results. A total of 2,217 patients with 6th AJCC stage IA–IIIB Siewert type II AEG was examined: 1,584 patients (71.4%) underwent PG, and 633 patients (28.6%) underwent TG. The follow-up time was 1–131 months. OS favored total gastrectomy before the PSM analysis (χ2=3.952, p=0.047), but after this analysis, there was no significant difference between TG and PG (χ2=2.227, p=0.136). The univariate and multivariate analyses identified age as an independent factor, and an X-tail analysis revealed 70 years as a cut-off point. The patients aged≥70 years obtained a significant long-term OS benefit from PG compared to TG (χ2=8.245, p=0.004), and those aged<70 years showed no difference between TG and PG (χ2=0.167, p=0.682). Conclusions. PG showed an equivalent survival benefit to TG in both the early and locally advanced stages of Siewert type II AEG. For elderly patients, PG is strongly recommended because of its clearer OS benefit compared to TG.

scholarly journals Novel abdominal approach for dissection of advanced type II/III adenocarcinoma of the esophagogastric junction: a new surgical option

2018 ◽  
Vol 47 (1) ◽  
pp. 398-410 ◽  
Author(s):  
Can Hu ◽  
Hao-te Zhu ◽  
Zhi-yuan Xu ◽  
Jian-fa Yu ◽  
Yi-an Du ◽  
...  
Keyword(s):  
Lymph Node ◽  
Survival Rate ◽  
Postoperative Complications ◽  
Total Gastrectomy ◽  
Surgical Approach ◽  
Esophagogastric Junction ◽  
Abdominal Cavity ◽  
Type Ii ◽  
Siewert Type ◽  
Siewert Type Ii

Objective The optimal surgical approach for Siewert type II adenocarcinoma of the esophagogastric junction (AEG) is controversial. In this study, we evaluated the outcomes of total gastrectomy for Siewert type II/III AEG via the left thoracic surgical approach that is used at our center. Methods We identified 41 patients with advanced AEG in our retrospective database and analyzed their 3-year survival rate, upper surgical margin, postoperative complications, and index of estimated benefit from lymph node dissection. Results The 3-year overall survival rate of the whole group was 63%, but no difference was observed between Siewert type II and III AEGs. Esophageal exposure and lymphadenectomy were sufficient. Eight patients developed postoperative complications, but none of the patients developed anastomotic leakage. Dissection of lymph node station Nos. 19 and 110 may be necessary for patients with Siewert type II AEG. Multivariate analysis revealed that the cT category was the only independent risk factor. Conclusions Total gastrectomy via an approach from the abdominal cavity into the thoracic cavity may be an optimal surgical technique for advanced Siewert type II AEG.

FA05.04: CLINICAL SIGNIFICANCE OF ESOPHAGEAL INVASION LENGTH FOR THE PREDICTION OF MEDIASTINAL LYMPH NODE METASTASIS IN SIEWERT TYPE II ADENOCARCINOMA

2018 ◽  
Vol 31 (Supplement_1) ◽  
pp. 10-11
Author(s):  
Kazuo Koyanagi ◽  
Fumihiko Kato ◽  
Jun Kanamori ◽  
Hiroyuki Daiko ◽  
Yuji Tachimori ◽  
...  
Keyword(s):  
Lymph Node ◽  
Lymph Node Metastasis ◽  
Mediastinal Lymph Node ◽  
Esophageal Wall ◽  
Type Ii ◽  
Mediastinal Lymph Node Metastasis ◽  
Siewert Type ◽  
Siewert Type Ii ◽  
Node Metastasis ◽  
Esophageal Invasion

Abstract Background We focused on the esophageal invasion length (EIL), defined as the distance from the EGJ to the proximal edge, of Siewert type II adenocarcinomas. This study investigated whether the EIL could be a possible indicator of mediastinal lymph node metastasis and survival in the Siewert type II patients. Methods The 168 consecutive patients with Siewert type II tumor who underwent surgery were enrolled. Metastatic stations and recurrent lymph node sites were classified into cervical, upper/middle/lower mediastinal, and abdominal zones. EIL was correlated with overall metastasis or recurrence in individual zones and survival. Results The ROC curve for EIL was generated to predict the rates of upper and middle mediastinal lymph node metastasis or recurrence, and the cut-off EIL value was determined to be 25 mm with an area under the curve of 0.83 (sensitivity, 80.8%; specificity, 72.3%). Siewert type II patients with an EIL of more than 25 mm (> 25 mm EIL group) had a higher incidence of overall metastasis or recurrence in the upper and middle mediastinal zones than those with an EIL of less than or equal to 25 mm (≤ 25 mm EIL group) (P = 0.001 and P < 0.001). Disease free and overall survival in the > 25 mm EIL group were significantly lower than those of the ≤ 25 mm EIL group (P < 0.001). None of the Siewert type II patients with metastasis or recurrence in the upper and middle mediastinal zones survived for more than five years. On the other hand, the efficacy index of the lower mediastinal lymph node and the abdominal lymph node were 5.6 and 21.7, respectively. Only EIL of more than 25 mm was a significant preoperative predictor of overall metastasis or recurrence in the upper and middle mediastinal zone (odds ratio, 8.85; 95% CI, 2.31−33.3; P = 0.001). Conclusion An EIL of more than 25 mm might be a preoperative predictor of overall metastasis or recurrence in the upper and middle mediastinal zones. A multimodal-therapeutic strategy should be investigated in Siewert type II patients once the tumor has invaded to the esophageal wall more than 25 mm. Disclosure All authors have declared no conflicts of interest.

Sign in / Sign up

Export Citation Format

Share Document