Annals of Surgical Oncology

, Volume 24, Issue 12, pp 3631–3639 | Cite as

Recurrence Pattern and Lymph Node Metastasis of Adenocarcinoma at the Esophagogastric Junction

  • Yun-Suhk Suh
  • Kyung-Goo Lee
  • Seung-Young Oh
  • Seong-Ho Kong
  • Hyuk-Joon Lee
  • Woo-Ho Kim
  • Han-Kwang Yang
Gastrointestinal Oncology

Abstract

Background

The surgical approach for adenocarcinoma of the esophagogastric junction (AEJ) still is controversial despite revised tumor-node-metastasis (TNM) classification. This study aimed to evaluate the oncologic outcome of a routine transhiatal approach for AEJ in terms of recurrence and lymph node (LN) metastasis of AEJ.

Methods

Recurrence patterns and LN metastasis of a single, primary AEJ (n = 463) treated by a surgical resection using a transhiatal approach without routine complete mediastinal LN dissection or routine splenectomy were analyzed respectively. To validate current treatment for recurrence, a validation index of recurrence (ViR; overall survival/incidence of solitary recurrence factor) was developed.

Results

The overall recurrence rate for AEJ was 20.3%, which did not differ significantly between AEJ II (20.8%; n = 125) and AEJ III (20.1%; n = 338). Mediastinal recurrence did not differ significantly among the subtypes of AEJ, irrespective of gastroesophageal junction involvement. Splenic hilar LN recurrence-free survival did not differ significantly between the gastrectomy-only group, the gastrectomy-plus-splenectomy group, and the gastrectomy plus distal pancreatectomy group. The solitary recurrence rate for the mediastinal LN was 0.7% for AEJ, and the overall median survival with that recurrence was 30.5 months. The ViR for mediastinal LN recurrence (43.6) was higher than for regional LN (20.9) or distant LN (14.6) metastasis.

Conclusion

In terms of LN metastasis and recurrence, a transhiatal approach without complete mediastinal LN dissection can be acceptable, and routine splenectomy is not necessary for AEJ II or AEJ III arising within the stomach.

Notes

Acknowledgments

This study was supported by Grant No. 30-2014-0090 from the Seoul National University Hospital research fund and a Grant of the Korea Health Technology R&D Project through the Korea Health Industry Development Institute funded by the Ministry of Health & Welfare, Republic of Korea (HI14C1277).

Conflict of interest

There are no conflicts of interest.

Supplementary material

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Copyright information

© Society of Surgical Oncology 2017

Authors and Affiliations

  • Yun-Suhk Suh
    • 1
  • Kyung-Goo Lee
    • 1
  • Seung-Young Oh
    • 1
  • Seong-Ho Kong
    • 1
  • Hyuk-Joon Lee
    • 1
    • 2
  • Woo-Ho Kim
    • 2
    • 3
  • Han-Kwang Yang
    • 1
    • 2
  1. 1.Department of SurgerySeoul National University College of MedicineSeoulKorea
  2. 2.Cancer Research InstituteSeoul National University College of MedicineSeoulKorea
  3. 3.Department of PathologySeoul National University College of MedicineSeoulKorea

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