Extent of Lymph Node Dissection for cStage I Siewert Type I/II Cancers Based on Lymph Node Metastasis Risk...

Area of Science:

• Gastroenterology
• Surgical Oncology
• Pathology

Background:

• Optimal surgical strategy for clinical Stage I adenocarcinoma of the esophagogastric junction (AEG) is debated.
• Extent of lymph node (LN) dissection requires clarification for early-stage AEG.

Purpose of the Study:

• Evaluate surgical outcomes in cStage I Siewert type I/II AEG.
• Determine prevalence and distribution of LN metastasis based on tumor characteristics.

Main Methods:

• Retrospective review of 151 patients with cStage I Siewert type I/II AEG.
• Analysis of LN metastasis in relation to tumor depth, size, Siewert type, and esophageal invasion length (EIL).
• Comparison of surgical outcomes between esophagectomy and gastrectomy with distal esophagectomy.

Main Results:

• 13.9% of patients had LN metastasis; no recurrence observed during follow-up.
• Metastases predominantly in abdominal LN stations (1, 2, 3, 7), exclusively in pT1b and pT2 tumors.
• Cervical/mediastinal LN metastases were rare, associated with larger tumors (≥35mm), Siewert type I, and longer EIL (≥30mm).
• Gastrectomy with distal esophagectomy had fewer complications (22.9%) than esophagectomy (50.0%).

Conclusions:

• LN metastasis in cStage I AEG is primarily abdominal.
• Specific tumor features may predict cervical/mediastinal LN involvement.
• Gastrectomy with distal esophagectomy and D1 LN dissection is oncologically adequate for select cStage I AEG patients.