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Extent of Lymph Node Dissection for cStage I Siewert Type I/II Cancers Based on Lymph Node Metastasis Risk
Masayoshi Terayama1, Akihiko Okamura1, Tomoyuki Irino1
1Department of Gastroenterological Surgery Cancer Institute Hospital, Japanese Foundation for Cancer Research Tokyo Japan.
Aim:
The optimal surgical strategy and extent of lymph node (LN) dissection for clinical Stage I (cStage I) adenocarcinoma of the esophagogastric junction (AEG) remain controversial. This study aimed to evaluate surgical outcomes and clarify the prevalence and distribution of LN metastasis according to tumor characteristics in cStage I Siewert type I/II AEG.
Methods:
We retrospectively reviewed 151 patients who underwent radical surgery for cStage I Siewert type I/II AEG. The prevalence and anatomical distribution of LN metastasis were analyzed in relation to tumor depth, tumor size, Siewert classification, and esophageal invasion length (EIL). Surgical outcomes were compared between esophagectomy and gastrectomy with distal esophagectomy.
Results:
LN metastasis was identified in 13.9% of patients, and no recurrence was observed during a median follow-up of 58.8 months. Metastases were predominantly located in abdominal LN stations (1, 2, 3, and 7), and occurred exclusively in pT1b and pT2 tumors. Cervical and mediastinal LN metastases were rare (approximately 1%) and were limited to those with tumor size ≥ 35 mm, Siewert type I classification, and an EIL of ≥ 30 mm. Gastrectomy with distal esophagectomy was associated with fewer postoperative complications (22.9% versus. 50.0%, p = 0.003) compared with esophagectomy.
Conclusion:
In cStage I AEG, LN metastasis is largely confined to the abdominal region. Cervical and mediastinal LN metastases are potentially associated with specific tumor characteristics. For patients without these features, gastrectomy with distal esophagectomy, including D1 abdominal LN dissection, represents an oncologically adequate procedure.
