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Risk factors and clinical significance of lower perigastric lymph node metastases in Siewert type II and III esophagogastric junction adenocarcinoma: a retrospective cohort study.
- Source :
-
Surgical endoscopy [Surg Endosc] 2024 Jul; Vol. 38 (7), pp. 3828-3837. Date of Electronic Publication: 2024 May 31. - Publication Year :
- 2024
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Abstract
- Background: No consensus has been concluded with regarding to the scope of lymph node (LN) dissection for Siewert type II and III adenocarcinoma of the esophagogastric junction (AEG). This study aimed to explore risk factors for lower perigastric LN (LPLN) metastases (including no. 4d, 5, 6, and 12a LN stations) and analyze the indications for LPLN dissection.<br />Methods: In total, 302 consecutive patients with Siewert type II and III AEG who underwent total gastrectomy (TG) were enrolled. The logistic regression model was used to perform uni- and multivariate analyses of risk factors for LPLN metastases. Kaplan-Meier curves were used for survival analysis, and log-rank tests were used for group comparisons. Basing on the guidelines of Japanese Gastric Cancer Association, the LN metastases (LNM) as well as the efficiency index (EI) of each LN station was further evaluated.<br />Results: The independent risk factors for LPLN metastases in patients with Siewert type II and III AEG were distance from the esophagogastric junction (EGJ) to the distal end of the tumor (> 4.0 cm), preoperative carcinoembryonic antigen (CEA) ( +), pT4 stage, and HER-2 ( +). LPLN metastases was an independent risk factor for overall survival following TG. The LNM and EI of LPLN were 8.6% and 2.31%, respectively. The LNM of LPLN > 10% under the stratification of the distance from the EGJ to the distal end of the tumor (> 4.0 cm), pT4, preoperative CEA ( +), and HER-2 ( +) exhibited EI values of 3.55%, 2.09%, 2.51%, and 3.64%, respectively.<br />Conclusions: LPLN metastases was a malignant factor for the prognosis of patients with Siewert type II and III AEG. For patients with preoperative CEA ( +), pT4 stage, HER-2 ( +), and the distance from the EGJ to the distal end of the tumor (> 4.0 cm), TG with LPLN dissection is prioritized for clinical recommendation.<br /> (© 2024. The Author(s).)
- Subjects :
- Humans
Male
Female
Retrospective Studies
Middle Aged
Risk Factors
Aged
Adult
Lymph Nodes pathology
Clinical Relevance
Esophagogastric Junction pathology
Adenocarcinoma surgery
Adenocarcinoma pathology
Lymphatic Metastasis
Stomach Neoplasms pathology
Stomach Neoplasms surgery
Gastrectomy methods
Lymph Node Excision
Esophageal Neoplasms pathology
Esophageal Neoplasms surgery
Subjects
Details
- Language :
- English
- ISSN :
- 1432-2218
- Volume :
- 38
- Issue :
- 7
- Database :
- MEDLINE
- Journal :
- Surgical endoscopy
- Publication Type :
- Academic Journal
- Accession number :
- 38822144
- Full Text :
- https://doi.org/10.1007/s00464-024-10875-y