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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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. 劉凱, 張維漢, 陳心足. 食管胃結合部腺癌的定義、分型和分期: 爭議中的進展. 中國普外基礎與臨床雜志, 2019, 26(9): 1040-1045.
7. 吳志勇, 孫隆慈, 張斌. 食管胃結合部癌定義與分型的再認識. 中華消化外科雜志, 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. 國際食管疾病學會中國分會食管胃結合部疾病跨界聯盟, 中國醫師協會內鏡醫師分會腹腔鏡外科專業委員會, 中國醫師協會外科醫師分會上消化道外科醫師專業委員會, 等. 食管胃結合部腺癌外科治療中國專家共識(2018年版). 中華胃腸外科雜志, 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. 中國醫師協會內鏡醫師分會腹腔鏡外科專業組, 國際食管疾病學會中國分會, 中國食管胃結合部腺癌研究協作組, 等. 食管胃結合部腺癌外科治療中國專家共識(2024年版). 中華胃腸外科雜志, 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. 杜書祥, 張璐璐, 王濤, 等. SiewertⅡ/Ⅲ型食管胃結合部腺癌腹腔各組淋巴結轉移率的meta分析和系統評價. 中國普外基礎與臨床雜志, 2022, 29(11): 1495-1502.
17. 趙保玉. 食管胃結合部癌手術切除方式和淋巴結清掃效能的臨床研究. 南方醫科大學, 2020.
18. 李珍艷, 顧一敏, 王文憑, 等. 從胸外科視角看Siewert Ⅱ型食管胃結合部腺癌的治療. 中華胃腸外科雜志, 2022, 25(2): 109-113.
19. 楊世界, 袁勇, 胡皓源, 等. Siewert-Ⅱ型食管胃結合部腺癌經胸與經腹入路手術的預后比較— 胸外科與胃腸外科聯合數據分析. 中華胃腸外科雜志, 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. 段曉峰, 弓磊, 馬明全, 等. SiewertⅡ型食管胃結合部腺癌Ivor-Lewis手術與左開胸術淋巴結清掃情況的比較. 中華腫瘤雜志, 2017, 39(3): 190-194.
24. 宋舜堯, 韓璐, 袁慶忠, 等. 完全腹腔鏡下經腹入路與經腹聯合開胸手術入路治療SiewertⅡ型食管胃結合部腺癌的對比研究. 中國普外基礎與臨床雜志, 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, 陳小龍. 食管胃結合部腺癌外科治療爭議、共識及進展. 中國普外基礎與臨床雜志, 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, 鄭智, 陳光勇, 等. Ⅱ/Ⅲ型胃食管結合部腺癌淋巴結轉移的危險因素及隨訪分析. 國際外科學雜志, 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.
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