Journal of Gastrointestinal Surgery

, Volume 23, Issue 2, pp 256–263 | Cite as

Should Pyloric Lymph Nodes Be Dissected for Siewert Type II and III Adenocarcinoma of the Esophagogastric Junctions: Experience from a High-Volume Center in China

  • Huihua Cao
  • Marie Ooi
  • Zhan Yu
  • Qing Wang
  • Zhong Li
  • Qicheng LuEmail author
  • Yugang WuEmail author
Original Article



The optimal extent of lymph node (LN) dissection remains controversial in adenocarcinoma of the esophagogastric junction (AEG), especially in Siewert types II and III. The aim of this study was to analyze clinicopathological characteristics of patients with Siewert type II and III AEGs to clarify whether pyloric (no. 5 and no.6) lymphadenectomy is essential in these patients.


A retrospective analysis was performed in the Third Affiliated Hospital of Soochow University from September 2008 to December 2012, and clinicopathological characteristics on all patients with Siewert type II and III AEGs, who underwent curative total gastrectomy with lymphadenectomy were collected. The index of estimated benefit from lymph node dissection (IEBLD) was used to evaluate the efficacy of lymph node dissection of no. 5 and no. 6. Both clinicopathological characteristics and IEBLDs were set as the standards in the assessment of the value of pyloric lymph nodes dissection.


A total of 216 patients with AEG (Siewert type II: 141, Siewert type III: 75) were included into the study. Type III AEG had a larger tumor size and relatively advanced T stage compared to Type II AEG. The 5-year overall survival (OS) rates in type II and type III AEGs were almost similar (type II 50.4% vs. type III 46.7%, p = 0.782). There was a very low incidence of pyloric lymph nodes metastases in type II AEG (no. 5 is 1.4% and no. 6 is 0.7%). Hence, the IEBLDs of no. 5 and no. 6 lymph node were negligible regardless of the T stage and tumor differentiation. In type III AEG, metastasis rates of no. 5 and no. 6 lymph node were 9.3 and 5.3%, respectively. The IEBLDs of no. 5 and no. 6 lymph node were 2.7 and 1.3, respectively.


Based on the IEBLDs of pyloric lymph nodes, dissection of no. 5 and no. 6 lymph nodes were worthwhile for Siewert type III AEG but not essential for Siewert type II AEG.


Adenocarcinoma of the esophagogastric junction Lymphadenectomy Siewert type II Siewert type III 


Author Contribution

Huihua Cao and Marie Ooi wrote the manuscript and analyzed clinicopathological data. Zhan Yu, Qing Wang and Zhong Li carried out the follow-ups and collected the clinicopathological data of patients. Yugang Wu and Qicheng Lu assisted Huihua Cao and Marie Ooi to complete the work and Yugang Wu funded the study.

Funding Information

The present study was supported by the Changzhou Municipal Scientific Research grant (grant no. CE20125020).

Compliance with Ethical Standards


The authors have no financial conflict of interest.


  1. 1.
    Goto H, Tokunaga M, Miki Y, Makuuchi R, Sugisawa N, Tanizawa Y, Bando E, Kawamura T, Niihara M, Tsubosa Y, Terashima M. The optimal extent of lymph node dissection for adenocarcinoma of the esophagogastric junction differs between Siewert type II and Siewert type III patients. Gastric cancer 2015;18:375–381.CrossRefGoogle Scholar
  2. 2.
    Xiao JW, Liu ZL, Ye PC, Luo YJ, Fu ZM, Zou Q, Wei SJ. Clinical comparison of antrum-preserving double tract reconstruction vs roux-en-Y reconstruction after gastrectomy for Siewert types II and III adenocarcinoma of the esophagogastric junction. World journal of gastroenterology 2015;21:9999–10007.CrossRefGoogle Scholar
  3. 3.
    Lee IS, Ahn JY, Yook JH, Kim BS. Mediastinal lymph node dissection and distal esophagectomy is not essential in early esophagogastric junction adenocarcinoma. World journal of surgical oncology 2017;15:28.CrossRefGoogle Scholar
  4. 4.
    Rudiger Siewert J, Feith M, Werner M, Stein HJ. Adenocarcinoma of the esophagogastric junction: results of surgical therapy based on anatomical/topographic classification in 1,002 consecutive patients. Annals of surgery 2000;232:353–361.CrossRefGoogle Scholar
  5. 5.
    Kodera Y, Yamamura Y, Shimizu Y, Torii A, Hirai T, Yasui K, Morimoto T, Kato T. Adenocarcinoma of the gastroesophageal junction in Japan: relevance of Siewert's classification applied to 177 cases resected at a single institution. Journal of the American College of Surgeons 1999;189:594–601.CrossRefGoogle Scholar
  6. 6.
    Brenkman HJF, Roelen SVS, Steenhagen E, Ruurda JP, van Hillegersberg R. Postoperative complications and weight loss following jejunostomy tube feeding after total gastrectomy for advanced adenocarcinomas. Chinese journal of cancer research 2017;29:333–340.CrossRefGoogle Scholar
  7. 7.
    Bae JM, Park JW, Yang HK, Kim JP. Nutritional status of gastric cancer patients after total gastrectomy. World journal of surgery 1998;22:254–260.CrossRefGoogle Scholar
  8. 8.
    Sasako M, McCulloch P, Kinoshita T, Maruyama K. New method to evaluate the therapeutic value of lymph node dissection for gastric cancer. The British journal of surgery 1995;82:346–351.CrossRefGoogle Scholar
  9. 9.
    Ilhan E, Ureyen O, Meral UM. Ongoing problems concerning 7(th) TNM staging system and proposals for 8(th) TNM staging system of gastric cancer. Przeglad gastroenterologiczny 2016;11:223–225.Google Scholar
  10. 10.
    Hasegawa S, Yoshikawa T, Cho H, Tsuburaya A, Kobayashi O. Is adenocarcinoma of the esophagogastric junction different between Japan and western countries? The incidence and clinicopathological features at a Japanese high-volume cancer center. World journal of surgery 2009;33:95–103.CrossRefGoogle Scholar
  11. 11.
    Chen XZ, Zhang WH, Hu JK. Lymph node metastasis and lymphadenectomy of resectable adenocarcinoma of the esophagogastric junction. Chinese journal of cancer research 2014;26:237–242.Google Scholar
  12. 12.
    Carboni F, Valle M, Federici O, Levi Sandri GB, Camperchioli L, Lapenta R, Assisi D, Garofalo A. Esophagojejunal anastomosis leakage after total gastrectomy for esophagogastric junction adenocarcinoma: options of treatment. Journal of gastrointestinal oncology 2016;7:515–522.CrossRefGoogle Scholar
  13. 13.
    Aday U, Gundes E, Ciyiltepe H, Cetin DA, Gulmez S, Senger AS, Deger KC, Duman M. Examination of anastomotic leak with aqueous contrast swallow after total gastrectomy: should it be carried out routinely? Contemporary oncology 2017;21:224–227.Google Scholar
  14. 14.
    Huh YJ, Lee HJ, Oh SY, Lee KG, Yang JY, Ahn HS, Suh YS, Kong SH, Lee KU, Yang HK. Clinical outcome of modified laparoscopy-assisted proximal gastrectomy compared to conventional proximal gastrectomy or total gastrectomy for upper-third early gastric cancer with special references to postoperative reflux esophagitis. Journal of gastric cancer 2015;15:191–200.CrossRefGoogle Scholar
  15. 15.
    Katsoulis IE, Robotis JF, Kouraklis G, Yannopoulos PA. What is the difference between proximal and total gastrectomy regarding postoperative bile reflux into the oesophagus? Digestive surgery 2006;23:325–330.CrossRefGoogle Scholar
  16. 16.
    Ahn HS, Lee HJ, Yoo MW, Jeong SH, Park DJ, Kim HH, Kim WH, Lee KU, Yang HK. Changes in clinicopathological features and survival after gastrectomy for gastric cancer over a 20-year period. The British journal of surgery 2011;98:255–260.CrossRefGoogle Scholar
  17. 17.
    Pu YW, Gong W, Wu YY, Chen Q, He TF, Xing CG. Proximal gastrectomy versus total gastrectomy for proximal gastric carcinoma. A meta-analysis on postoperative complications, 5-year survival, and recurrence rate. Saudi medical journal 2013;34:1223–1228.Google Scholar
  18. 18.
    Nunobe S, Hiki N. Function-preserving surgery for gastric cancer: current status and future perspectives. Translational gastroenterology and hepatology 2017;2:77.CrossRefGoogle Scholar
  19. 19.
    Aratani K, Komatsu S, Ichikawa D, et al. Overexpression of EGFR as an independent prognostic factor in adenocarcinoma of the esophagogastric junction. Anticancer Res 2017;37:3129–3135.Google Scholar
  20. 20.
    Hosoda K, Yamashita K, Moriya H, Mieno H, Watanabe M. Optimal treatment for Siewert type II and III adenocarcinoma of the esophagogastric junction: a retrospective cohort study with long-term follow-up. World Journal of Gastroenterology 2017;23:2723–2730.CrossRefGoogle Scholar
  21. 21.
    Yamashita H, Katai H, Morita S, Saka M, Taniguchi H, Fukagawa T. Optimal extent of lymph node dissection for Siewert type II esophagogastric junction carcinoma. Annals of surgery 2011;254:274–280.CrossRefGoogle Scholar
  22. 22.
    Fujitani K, Miyashiro I, Mikata S, Tamura S, Imamura H, Hara J, Kurokawa Y, Fujita J, Nishikawa K, Kimura Y, Takiguchi S, Mori M, Doki Y. Pattern of abdominal nodal spread and optimal abdominal lymphadenectomy for advanced Siewert type II adenocarcinoma of the cardia: results of a multicenter study. Gastric Cancer 2013;16:301–308.CrossRefGoogle Scholar
  23. 23.
    Miwa K, Kinami S, Taniguchi K, Fushida S, Fujimura T, Nonomura A. Mapping sentinel nodes in patients with early-stage gastric carcinoma. The British Journal Of Surgery 2003;90:178–182.CrossRefGoogle Scholar
  24. 24.
    Shen KR, Cassivi SD, Deschamps C, Allen MS, Nichols FC, Harmsen WS, Pairolero PC. Surgical treatment of tumors of the proximal stomach with involvement of the distal esophagus: a 26-year experience with Siewert type III tumors. The Journal of Thoracic and Cardiovascular Surgery 2006;132:755–762.CrossRefGoogle Scholar
  25. 25.
    Mocellin S, McCulloch P, Kazi H, Gama-Rodrigues JJ, Yuan Y, Nitti D. Extent of lymph node dissection for adenocarcinoma of the stomach. The Cochrane Database of Systematic Reviews 2015;Cd001964.Google Scholar

Copyright information

© The Society for Surgery of the Alimentary Tract 2018

Authors and Affiliations

  1. 1.Department of General SurgeryThe Third Affiliated Hospital of Soochow University and The First People’s Hospital of ChangzhouChangzhouChina
  2. 2.Gastroenterology DepartmentRoyal Adelaide HospitalAdelaideAustralia

Personalised recommendations