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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.

Authors :
Qi, Xinyu
Liu, Maoxing
Xu, Kai
Tan, Fei
Gao, Pin
Yao, Zhendan
Zhang, Nan
Yang, Hong
Zhang, Chenghai
Xing, Jiadi
Cui, Ming
Su, Xiangqian
Source :
Surgical Endoscopy & Other Interventional Techniques; Jul2024, Vol. 38 Issue 7, p3828-3837, 10p
Publication Year :
2024

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. 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. 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. 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. [ABSTRACT FROM AUTHOR]

Details

Language :
English
ISSN :
18666817
Volume :
38
Issue :
7
Database :
Complementary Index
Journal :
Surgical Endoscopy & Other Interventional Techniques
Publication Type :
Academic Journal
Accession number :
178230381
Full Text :
https://doi.org/10.1007/s00464-024-10875-y