Mediastinal lymph node dissection and distal esophagectomy is not essential in early esophagogastric junction...

Optimal extent of surgery remains controversial in types 2 and 3 adenocarcinoma of esophagogastric junction (AEG). We aimed to determine whether the extended procedure including mediastinal lymphadenectomy is essential in all patients with AEG by comparing prognosis and recurrence of proximal gastric adenocarcinoma based on total gastrectomy with intra-abdominal lymphadenectomy.

The clinicopathologic characteristics of 672 patients (type 2: 90, type 3: 211, upper third of the stomach: 371 cases) who underwent curative total gastrectomy with lymphadenectomy between 2003 and 2009 were reviewed.

Recurrence was observed in 36.7, 16.1, and 16.1% of cases of type 2 AEG, type 3 AEG, and cancer of the upper third of the stomach, respectively. The 5-year disease-free survival rates were 62.6, 82.5, and 84.6%, respectively. Subgroup analysis revealed that in early cancers, there was no difference in survival between the groups (93.2 vs. 96.7 vs. 98.7%) but in advanced cancers, there was a difference (47.9 vs. 75.4 vs. 71.8%, P < 0.001). There was no survival difference in stage 1 (97.5 vs. 98.7 vs. 98.3%), but, in stage 2, type 2 AEG had a worse prognosis (41.9 vs. 92.1 vs. 83.0%). Types 2 and 3 advanced AEG had higher rates of locoregional recurrence, especially in the vicinity of the esophagojejunostomy and mediastinal lymph nodes compared to proximal gastric cancer.

Total gastrectomy without mediastinal lymphadenectomy might produce favorable outcomes in early AEG and acquisition of a greater length of proximal margin, and removal of mediastinal lymph nodes might be helpful in advanced cancers.