Research updates on lymph node metastasis and dissection value in adenocarcinoma of the esophagogastric junction_CHINESE JOURNAL OF BASES AND CLINICS IN GENERAL SURGERY

Authors：

YU Tianhang ¹ , ZHANG Weihan ¹ ,  CHEN Xinzu ^1,2,3 ,  HU Jiankun ¹

1. Gastric Cancer Center & Gastric Cancer Laboratory, Department of General Surgery, West China Hospital, Sichuan University, Chengdu 610041, P. R. China;
2. Ya’an Cancer Prevention and Control Center, Ya’an People’s Hospital (West China Ya’an Hospital, Sichuan University), Ya’an, Sichuan 625000, P. R. China;
3. Ya’an Key Laboratory for Plateau Medicine, Ya’an People’s Hospital (West China Ya’an Hospital, Sichuan University), Ya’an, Sichuan 625000, P. R. China;

Corresponding author：

CHEN Xinzu, Email: chenxinzu@scu.edu.cn; HU Jiankun, Email: hujkwch@126.com

Keywords：

adenocarcinoma of the esophagogastric junction; esophageal cancer; gastric cancer; lymph node dissection; survival

DOI：

10.7507/1007-9424.202403056

Video：

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Objective To review the lymph node metastasis pattern and its dissection value among adenocarcinoma of the esophagogastric junction (AEG) patients, in order to assist suitable individualized lymph node dissection strategies for diverse AEG patients. Methods The reports about lymph node metastasis and the value of dissection of AEG worldwide in recent years were retrieved and summarized. Results The sites with higher lymph node metastasis rate of AEG included No.1, No.2, No.3, No.7 lymph nodes, etc. and sites with higher lymph node metastasis rate often benefit from dissection. Lymph node metastasis was related to factors such as tumor size and location, and lymph node dissection at individual sites is still controversial. Conclusion The lymph node dissection range of AEG is highly controversial, especially for Siewert type Ⅱ AEG, which still requires prospective multicenter studies to prove.

Citation： YU Tianhang, ZHANG Weihan, CHEN Xinzu, HU Jiankun. Research updates on lymph node metastasis and dissection value in adenocarcinoma of the esophagogastric junction. CHINESE JOURNAL OF BASES AND CLINICS IN GENERAL SURGERY, 2024, 31(8): 1005-1011. doi: 10.7507/1007-9424.202403056 Copy

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19.	杨世界, 袁勇, 胡皓源, 等. Siewert-Ⅱ型食管胃结合部腺癌经胸与经腹入路手术的预后比较— 胸外科与胃肠外科联合数据分析. 中华胃肠外科杂志, 2019, 22(2): 132-142.
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24.	宋舜尧, 韩璐, 袁庆忠, 等. 完全腹腔镜下经腹入路与经腹联合开胸手术入路治疗SiewertⅡ型食管胃结合部腺癌的对比研究. 中国普外基础与临床杂志, 2020, 27(10): 1259-1265.
25.	Sasako M, Sano T, Yamamoto S, et al. Left thoracoabdominal approach versus abdominal-transhiatal approach for gastric cancer of the cardia or subcardia: a randomised controlled trial. Lancet Oncol, 2006, 7(8): 644-651.
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1. Sung H, Ferlay J, Siegel RL, et al. Global cancer statistics 2020: GLOBOCAN estimates of incidence and mortality worldwide for 36 cancers in 185 countries. CA Cancer J Clin, 2021, 71(3): 209-249.
2. Qi J, Li M, Wang L, et al. National and subnational trends in cancer burden in China, 2005-20: an analysis of national mortality surveillance data. Lancet Public Health, 2023, 8(12): e943-e955. doi: 10.1016/S2468-2667(23)00211-6.
3. Oberoi M, Noor MS, Abdelfatah E. The multidisciplinary approach and surgical management of GE junction adenocarcinoma. Cancers (Basel), 2024, 16(2): 288. doi: 10.3390/cancers16020288.
4. Agarwal S, Bell MG, Dhaliwal L, et al. Population based time trends in the epidemiology and mortality of gastroesophageal junction and esophageal adenocarcinoma. Dig Dis Sci, 2024, 69(1): 246-253.
5. Shoji Y, Koyanagi K, Kanamori K, et al. Current status and future perspectives for the treatment of resectable locally advanced esophagogastric junction cancer: a narrative review. World J Gastroenterol, 2023, 29(24): 3758-3769.
6. 刘凯, 张维汉, 陈心足. 食管胃结合部腺癌的定义、分型和分期: 争议中的进展. 中国普外基础与临床杂志, 2019, 26(9): 1040-1045.
7. 吴志勇, 孙隆慈, 张斌. 食管胃结合部癌定义与分型的再认识. 中华消化外科杂志, 2023, 22(12): 1404-1408.
8. Chen XZ, Zhang WH, Hu JK. Lymph node metastasis and lymphadenectomy of resectable adenocarcinoma of the esophagogastric junction. Chin J Cancer Res, 2014, 26(3): 237-242.
9. 国际食管疾病学会中国分会食管胃结合部疾病跨界联盟, 中国医师协会内镜医师分会腹腔镜外科专业委员会, 中国医师协会外科医师分会上消化道外科医师专业委员会, 等. 食管胃结合部腺癌外科治疗中国专家共识(2018年版). 中华胃肠外科杂志, 2018, 21(9): 961-975.
10. Rice TW, Ishwaran H, Ferguson MK, et al. Cancer of the esophagus and esophagogastric junction: an eighth edition staging primer. J Thorac Oncol, 2017, 12(1): 36-42.
11. Siewert JR, Stein HJ. Classification of adenocarcinoma of the oesophagogastric junction. Br J Surg, 1998, 85(11): 1457-1459.
12. Japanese Gastric Cancer Association. Japanese Gastric Cancer Treatment Guidelines 2021 (6th edition). Gastric Cancer, 2023, 26(1): 1-25.
13. 中国医师协会内镜医师分会腹腔镜外科专业组, 国际食管疾病学会中国分会, 中国食管胃结合部腺癌研究协作组, 等. 食管胃结合部腺癌外科治疗中国专家共识(2024年版). 中华胃肠外科杂志, 2024, 27(2): 109-261.
14. Sasako M, McCulloch P, Kinoshita T, et al. New method to evaluate the therapeutic value of lymph node dissection for gastric cancer. Br J Surg, 1995, 82(3): 346-351.
15. Kurokawa Y, Takeuchi H, Doki Y, et al. Mapping of lymph node metastasis from esophagogastric junction tumors: a prospective nationwide multicenter study. Ann Surg, 2021, 274(1): 120-127.
16. 杜书祥, 张璐璐, 王涛, 等. SiewertⅡ/Ⅲ型食管胃结合部腺癌腹腔各组淋巴结转移率的meta分析和系统评价. 中国普外基础与临床杂志, 2022, 29(11): 1495-1502.
17. 赵保玉. 食管胃结合部癌手术切除方式和淋巴结清扫效能的临床研究. 南方医科大学, 2020.
18. 李珍艳, 顾一敏, 王文凭, 等. 从胸外科视角看Siewert Ⅱ型食管胃结合部腺癌的治疗. 中华胃肠外科杂志, 2022, 25(2): 109-113.
19. 杨世界, 袁勇, 胡皓源, 等. Siewert-Ⅱ型食管胃结合部腺癌经胸与经腹入路手术的预后比较— 胸外科与胃肠外科联合数据分析. 中华胃肠外科杂志, 2019, 22(2): 132-142.
20. Kurokawa Y, Sasako M, Sano T, et al. Ten-year follow-up results of a randomized clinical trial comparing left thoracoabdominal and abdominal transhiatal approaches to total gastrectomy for adenocarcinoma of the oesophagogastric junction or gastric cardia. Br J Surg, 2015, 102(4): 341-348.
21. Duan X, Shang X, Tang P, et al. Lymph node dissection for Siewert Ⅱ esophagogastric junction adenocarcinoma: a retrospective study of 136 cases. ANZ J Surg, 2018, 88(4): E264-E267. doi: 10.1111/ans.13980.
22. Duan XF, Yue J, Tang P, et al. Lymph node dissection for Siewert Ⅱ esophagogastric junction adenocarcinoma: a retrospective study of 3 surgical procedures. Medicine (Baltimore), 2017, 96(7): e6120. doi: 10.1097/MD.0000000000006120.
23. 段晓峰, 弓磊, 马明全, 等. SiewertⅡ型食管胃结合部腺癌Ivor-Lewis手术与左开胸术淋巴结清扫情况的比较. 中华肿瘤杂志, 2017, 39(3): 190-194.
24. 宋舜尧, 韩璐, 袁庆忠, 等. 完全腹腔镜下经腹入路与经腹联合开胸手术入路治疗SiewertⅡ型食管胃结合部腺癌的对比研究. 中国普外基础与临床杂志, 2020, 27(10): 1259-1265.
25. Sasako M, Sano T, Yamamoto S, et al. Left thoracoabdominal approach versus abdominal-transhiatal approach for gastric cancer of the cardia or subcardia: a randomised controlled trial. Lancet Oncol, 2006, 7(8): 644-651.
26. Chen XD, He FQ, Liao MS, et al. Laparoscopic versus open transhiatal approach for adenocarcinoma of the esophagogastric junction: a systematic review and meta-analysis. Eur J Surg Oncol, 2021, 47(4): 778-788.
27. Shiraishi O, Yasuda T, Kato H, et al. Risk factors and prognostic impact of mediastinal lymph node metastases in patients with esophagogastric junction cancer. Ann Surg Oncol, 2020, 27(11): 4433-4440.
28. Feng H, Zheng J, Zheng C, et al. The probability of Lymph node metastasis with a tumor size larger than and smaller than 4 cm is different in stages T1-T3 of Siewert type Ⅱ adenocarcinoma of esophagogastric junction: a population-based study. J Cancer, 2021, 12(22): 6873-6882.
29. 胡建昆, 陈小龙. 食管胃结合部腺癌外科治疗争议、共识及进展. 中国普外基础与临床杂志, 2023, 30(10): 1153-1158.
30. Harada K, Hwang H, Wang X, et al. Frequency and implications of paratracheal lymph node metastases in resectable esophageal or gastroesophageal junction adenocarcinoma. Ann Surg, 2021, 273(4): 751-757.
31. 徐瑞, 郑智, 陈光勇, 等. Ⅱ/Ⅲ型胃食管结合部腺癌淋巴结转移的危险因素及随访分析. 国际外科学杂志, 2020, 47(10): 673-678, f3.
32. Hosokawa Y, Kinoshita T, Konishi M, et al. Clinicopathological features and prognostic factors of adenocarcinoma of the esophagogastric junction according to Siewert classification: experiences at a single institution in Japan. Ann Surg Oncol, 2012, 19(2): 677-683.
33. Yamashita H, Katai H, Morita S, et al. Optimal extent of lymph node dissection for Siewert type Ⅱesophagogastric junction carcinoma. Ann Surg, 2011, 254(2): 274-280.
34. Zhang X, He XD, Zhang YC, et al. Characteristics of lymph node (No. 5 and No. 6) metastasis and significance of lymph node dissection in Siewert type Ⅱ esophagogastric junction adenocarcinoma (AEG): No. 5 and No. 6 lymph node metastases of AEG and clearance. Medicine (Baltimore), 2021, 100(35): e27106. doi: 10.1097/MD.0000000000027106.
35. Japanese Gastric Cancer Association. Japanese gastric cancer treatment guidelines 2018 (5th edition). Gastric Cancer, 2021, 24(1): 1-21.
36. Goto H, Tokunaga M, Miki Y, et al. The optimal extent of lymph node dissection for adenocarcinoma of the esophagogastric junction differs between Siewert typeⅡ and Siewert type Ⅲ patients. Gastric Cancer, 2014, 18(2): 375-381.
37. Cao H, Ooi M, Yu Z, et al. Should pyloric lymph nodes be dissected for Siewert typeⅡ andⅢadenocarcinoma of the esophagogastric junctions: experience from a high-volume center in China. J Gastrointest Surg, 2019, 23(2): 256-263.
38. 李明, 孟庆彬, 邵永胜, 等. SiewertⅡ型食管胃结合部腺癌的幽门周围淋巴结清除的意义. 腹部外科, 2018, 31(4): 238-240, 244.
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