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Can proximal Gastrectomy Be Justified for Advanced Adenocarcinoma of the Esophagogastric Junction?

  • Sato, Yuya (Division of Gastric Surgery, National Cancer Center Hospital) ;
  • Katai, Hitoshi (Division of Gastric Surgery, National Cancer Center Hospital) ;
  • Ito, Maiko (Division of Gastric Surgery, National Cancer Center Hospital) ;
  • Yura, Masahiro (Division of Gastric Surgery, National Cancer Center Hospital) ;
  • Otsuki, Sho (Division of Gastric Surgery, National Cancer Center Hospital) ;
  • Yamagata, Yukinori (Division of Gastric Surgery, National Cancer Center Hospital) ;
  • Morita, Shinji (Division of Gastric Surgery, National Cancer Center Hospital)
  • 투고 : 2018.06.26
  • 심사 : 2018.10.28
  • 발행 : 2018.12.31

초록

Purpose: To evaluate the status of number 3b lymph node (LN) station in patients with adenocarcinoma of the esophagogastric junction (AEG) and to investigate the optimal indications for radical proximal gastrectomy (PG) for AEG. Materials and Methods: Data of 51 patients with clinically advanced Siewert types II and III AEG who underwent total gastrectomy (TG) between April 2010 and July 2017 were reviewed. The proportion of metastatic LNs at each LN station was examined. Number 3 LN station was separately classified into number 3a and number 3b. The risk factors for number 3b LN metastasis and the clinicopathological features of number 3b-positive AEG patients were investigated. Results: The incidences of LN metastasis were the highest in number 1 (47.1%), followed by number 2 (23.5%), number 3a (39.2%), and number 7 (23.5%) LN stations. LN metastasis in number 3b LN station was detected in 4 patients (7.8%). A gastric invasion length of more than 40 mm was a significant risk factor for number 3b LN metastasis. All 4 patients with number 3b-positive AEG had advanced cancer with a gastric invasion length of more than 40 mm. The 5-year survival rate of patients with a gastric invasion length of more than 40 mm was 50.0%. Conclusions: Radical PG may be indicated for patients with AEG with gastric invasion length of less than 40 mm.

키워드

참고문헌

  1. Yamashita K, Sakuramoto S, Nemoto M, Shibata T, Mieno H, Katada N, et al. Trend in gastric cancer: 35 years of surgical experience in Japan. World J Gastroenterol 2011;17:3390-3397. https://doi.org/10.3748/wjg.v17.i29.3390
  2. Kusano C, Gotoda T, Khor CJ, Katai H, Kato H, Taniguchi H, et al. Changing trends in the proportion of adenocarcinoma of the esophagogastric junction in a large tertiary referral center in Japan. J Gastroenterol Hepatol 2008;23:1662-1665. https://doi.org/10.1111/j.1440-1746.2008.05572.x
  3. Pohl H, Welch HG. The role of overdiagnosis and reclassification in the marked increase of esophageal adenocarcinoma incidence. J Natl Cancer Inst 2005;97:142-146. https://doi.org/10.1093/jnci/dji024
  4. Japanese Gastric Cancer Association. Japanese gastric cancer treatment guidelines 2014 (ver. 4). Gastric Cancer 2017;20:1-19.
  5. Yoshikawa T, Takeuchi H, Hasegawa S, Nozaki I, Kishi K, Ito S, et al. Theoretical therapeutic impact of lymph node dissection on adenocarcinoma and squamous cell carcinoma of the esophagogastric junction. Gastric Cancer 2016;19:143-149. https://doi.org/10.1007/s10120-014-0439-y
  6. Hiki N, Nunobe S, Kubota T, Jiang X. Function-preserving gastrectomy for early gastric cancer. Ann Surg Oncol 2013;20:2683-2692. https://doi.org/10.1245/s10434-013-2931-8
  7. Katai H, Sano T, Fukagawa T, Shinohara H, Sasako M. Prospective study of proximal gastrectomy for early gastric cancer in the upper third of the stomach. Br J Surg 2003;90:850-853. https://doi.org/10.1002/bjs.4106
  8. Goto H, Tokunaga M, Miki Y, Makuuchi R, Sugisawa N, Tanizawa Y, et al. 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. https://doi.org/10.1007/s10120-014-0364-0
  9. 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. Ann Surg 2011;254:274-280. https://doi.org/10.1097/SLA.0b013e3182263911
  10. 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 J Gastroenterol 2017;23:2723-2730. https://doi.org/10.3748/wjg.v23.i15.2723
  11. Hasegawa S, Yoshikawa T, Rino Y, Oshima T, Aoyama T, Hayashi T, et al. Priority of lymph node dissection for Siewert type II/III adenocarcinoma of the esophagogastric junction. Ann Surg Oncol 2013;20:4252-4259. https://doi.org/10.1245/s10434-013-3036-0
  12. Sano T, Aiko T. New Japanese classifications and treatment guidelines for gastric cancer: revision concepts and major revised points. Gastric Cancer 2011;14:97-100. https://doi.org/10.1007/s10120-011-0040-6
  13. Sasako M, Shinohara H. Perspective on gastric cancer. In: Zinner MJ, Ashley SW, eds. Maingot's Abdominal Operations. 12th ed. New York (NY): McGraw-Hill; 2012:489-491.
  14. Morita S, Katai H, Saka M, Fukagawa T, Sano T, Sasako M. Outcome of pylorus-preserving gastrectomy for early gastric cancer. Br J Surg 2008;95:1131-1135. https://doi.org/10.1002/bjs.6295
  15. Aizawa M, Honda M, Hiki N, Kinoshita T, Yabusaki H, Nunobe S, et al. Oncological outcomes of function-preserving gastrectomy for early gastric cancer: a multicenter propensity score matched cohort analysis comparing pylorus-preserving gastrectomy versus conventional distal gastrectomy. Gastric Cancer 2017;20:709-717. https://doi.org/10.1007/s10120-016-0644-y
  16. Takiguchi N, Takahashi M, Ikeda M, Inagawa S, Ueda S, Nobuoka T, et al. Long-term quality-of-life comparison of total gastrectomy and proximal gastrectomy by postgastrectomy syndrome assessment scale (PGSAS-45): a nationwide multi-institutional study. Gastric Cancer 2015;18:407-416. https://doi.org/10.1007/s10120-014-0377-8
  17. Jung DH, Ahn SH, Park DJ, Kim HH. Proximal gastrectomy for gastric cancer. J Gastric Cancer 2015;15:77-86. https://doi.org/10.5230/jgc.2015.15.2.77
  18. Nomura E, Okajima K. Function-preserving gastrectomy for gastric cancer in Japan. World J Gastroenterol 2016;22:5888-5895. https://doi.org/10.3748/wjg.v22.i26.5888
  19. Mine S, Kurokawa Y, Takeuchi H, Kishi K, Ito Y, Ohi M, et al. Distribution of involved abdominal lymph nodes is correlated with the distance from the esophagogastric junction to the distal end of the tumor in Siewert type II tumors. Eur J Surg Oncol 2015;41:1348-1353. https://doi.org/10.1016/j.ejso.2015.05.004
  20. Sasako M, McCulloch P, Kinoshita T, Maruyama K. New method to evaluate the therapeutic value of lymph node dissection for gastric cancer. Br J Surg 1995;82:346-351. https://doi.org/10.1002/bjs.1800820321

피인용 문헌

  1. A novel method of esophagogastrostomy by overlap anastomosis with placement of the remnant stomach into the lower mediastinum after laparoscopic proximal gastrectomy vol.14, pp.3, 2018, https://doi.org/10.1111/ases.12906