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Optimal Extent of Lymph Node Dissection for Siewert Type II Esophagogastric Junction Adenocarcinoma
Jun Peng1, Wen-Ping Wang1, Yong Yuan1
1Department of Thoracic Surgery, West China Hospital of Sichuan University, Chengdu, Sichuan, China.
Background:
The optimal surgical approach and extent of lymphadenectomy for Siewert type II adenocarcinoma of the esophagogastric junction (AEG) is controversial. The aim of this study was to identify its optimal extent of thoracic and abdominal lymph node dissection, and the appropriate surgical approach.
Methods:
The clinicopathologic data of 192 patients with Siewert type II AEG who were admitted to our center during January 2007 through October 2011 were retrospectively analyzed. We used the index of estimated benefit from lymph node dissection to assess the therapeutic value of lymph node dissection of each station.
Results:
Overall, for the thoracic lymph node dissection, the left thoracic route and Ivor-Lewis procedure are better choices than the abdominotranshiatal route. While for the abdominal lymph node dissection, the abdominotranshiatal achieved a better dissection extent. No significant difference was found in metastatic frequency for each station except the 16th station. The multivariate analysis found only N stage (p = 0.000) and number of resected lymph nodes of 12 or more (p = 0.035) were prognostic factors for Siewert type II AEG. Furthermore, we identified two thoracic lymph node stations (8M and 8L) and six abdominal lymph node stations (16, 17, 19, 20, G3, G4) that have a high therapeutic value for the patients.
Conclusions:
We recommend the 8M, 8L, 16, 17, and G3 should be excised for Siewert type II AEG. Considering the lymphadenectomy, the Ivor-Lewis procedure is the optimal choice for patients with Siewert type II AEG.
