Retrospective Cohort Study
Copyright ©The Author(s) 2017. Published by Baishideng Publishing Group Inc. All rights reserved.
World J Gastroenterol. Apr 21, 2017; 23(15): 2723-2730
Published online Apr 21, 2017. doi: 10.3748/wjg.v23.i15.2723
Optimal treatment for Siewert type II and III adenocarcinoma of the esophagogastric junction: A retrospective cohort study with long-term follow-up
Kei Hosoda, Keishi Yamashita, Hiromitsu Moriya, Hiroaki Mieno, Masahiko Watanabe
Kei Hosoda, Keishi Yamashita, Hiromitsu Moriya, Hiroaki Mieno, Masahiko Watanabe, Department of Surgery, Kitasato University School of Medicine, Kanagawa 252-0374, Japan
Author contributions: All the authors contributed equally to this paper.
Institutional review board statement: The study was reviewed and approved for publication by the Kitasato University Hospital Institutional Review Board.
Informed consent statement: All study participants or their legal guardians provided informed written consent regarding personal and medical data collection prior to study enrollment.
Conflict-of-interest statement: No potential conflicts of interest relevant to this article were reported.
Data sharing statement: The original anonymous dataset is available on request from the corresponding author at k.hosoda@kitasato-u.ac.jp.
Open-Access: This article is an open-access article which was selected by an in-house editor and fully peer-reviewed by external reviewers. It is distributed in accordance with the Creative Commons Attribution Non Commercial (CC BY-NC 4.0) license, which permits others to distribute, remix, adapt, build upon this work non-commercially, and license their derivative works on different terms, provided the original work is properly cited and the use is non-commercial. See: http://creativecommons.org/licenses/by-nc/4.0/
Correspondence to: Kei Hosoda, MD, PhD, Department of Surgery, Kitasato University, Kitasato 1-15-1, Minami-ku, Sagamihara, Kanagawa, 252-0374, Japan. k.hosoda@kitasato-u.ac.jp
Telephone: +81-42-7788111 Fax: +81-42-7789556
Received: December 26, 2017
Peer-review started: December 27, 2017
First decision: February 10, 2017
Revised: February 21, 2017
Accepted: March 21, 2017
Article in press: March 21, 2017
Published online: April 21, 2017
Processing time: 114 Days and 20.2 Hours
Abstract
AIM

To determine the optimal treatment strategy for Siewert type II and III adenocarcinoma of the esophagogastric junction.

METHODS

We retrospectively reviewed the medical records of 83 patients with Siewert type II and III adenocarcinoma of the esophagogastric junction and calculated both an index of estimated benefit from lymph node dissection for each lymph node (LN) station and a lymph node ratio (LNR: ratio of number of positive lymph nodes to the total number of dissected lymph nodes). We used Cox proportional hazard models to clarify independent poor prognostic factors. The median duration of observation was 73 mo.

RESULTS

Indices of estimated benefit from LN dissection were as follows, in descending order: lymph nodes (LN) along the lesser curvature, 26.5; right paracardial LN, 22.8; left paracardial LN, 11.6; LN along the left gastric artery, 10.6. The 5-year overall survival (OS) rate was 58%. Cox regression analysis revealed that vigorous venous invasion (v2, v3) (HR = 5.99; 95%CI: 1.71-24.90) and LNR of > 0.16 (HR = 4.29, 95%CI: 1.79-10.89) were independent poor prognostic factors for OS.

CONCLUSION

LN along the lesser curvature, right and left paracardial LN, and LN along the left gastric artery should be dissected in patients with Siewert type II or III adenocarcinoma of the esophagogastric junction. Patients with vigorous venous invasion and LNR of > 0.16 should be treated with aggressive adjuvant chemotherapy to improve survival outcomes.

Keywords: Adenocarcinoma of the esophagogastric junction; Lymph node ratio; Venous invasion; Lymph node dissection; Prognostic factor

Core tip: We reviewed the medical records of 83 patients with Siewert type II and III adenocarcinoma of the esophagogastric junction. The median duration of observation was 73 mo. Lymph nodes along the lesser curvature, right and left paracardial lymph nodes, and lymph nodes along the left gastric artery should be dissected in patients with Siewert type II or III adenocarcinoma of the esophagogastric junction. Patients with vigorous venous invasion and lymph node ratio of > 0.16 should be treated with aggressive adjuvant chemotherapy to improve survival outcomes.