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Lymph node metastasis from cancer of the esophagogastric junction, and determination of the appropriate nodal dissection

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Abstract

Purpose

Both squamous cell carcinomas and adenocarcinomas can develop in the esophagogastric junction. To clarify the appropriate lymph node dissection range, lymph node metastases from cancers in the esophagogastric junction were investigated.

Methods

The nodal metastases were analyzed in 64 patients with squamous cell carcinoma and 129 with adenocarcinoma according to Siewert’s classification, which is based on topographic anatomical criteria for adenocarcinoma.

Results

The squamous cell carcinomas located above the esophagocardial junction had more frequent metastasis to the lower and middle mediastinal lymph nodes in proportion to the depth of the tumor. Nodal metastasis was also often detected in the abdominal lymph nodes. In contrast, adenocarcinomas metastasized less frequently to the mediastinal lymph nodes, and the metastatic rates in the abdominal nodes were higher than those from squamous cell carcinoma.

Conclusion

Esophagectomy with mediastinal and abdominal lymph node dissection is considered to be an appropriate approach for surgical resection of squamous cell carcinomas, whereas transhiatally extended gastrectomy with lower mediastinal and abdominal lymph node dissection is recommended for the treatment of adenocarcinomas.

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Authors and Affiliations

  1. Department of Surgery and Science, Graduate School of Medical Sciences, Kyushu University, Maidashi 3-1-1, Higashi-ku, Fukuoka, 812-8582, Japan

    Yoshihiro Kakeji, Manabu Yamamoto, Akinori Egashira, Masaru Morita & Yoshihiko Maehara

  2. Department of Gastroenterological Surgery, National Kyushu Cancer Center, Fukuoka, Japan

    Shuhei Ito, Masahiko Sugiyama, Hiroshi Saeki, Yoshihisa Sakaguchi & Yasushi Toh

Authors
  1. Yoshihiro Kakeji
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  2. Manabu Yamamoto
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  3. Shuhei Ito
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  4. Masahiko Sugiyama
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  5. Akinori Egashira
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  6. Hiroshi Saeki
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  7. Masaru Morita
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  8. Yoshihisa Sakaguchi
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  9. Yasushi Toh
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  10. Yoshihiko Maehara
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Correspondence to Yoshihiro Kakeji.

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Kakeji, Y., Yamamoto, M., Ito, S. et al. Lymph node metastasis from cancer of the esophagogastric junction, and determination of the appropriate nodal dissection. Surg Today 42, 351–358 (2012). https://doi.org/10.1007/s00595-011-0114-4

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  • DOI: https://doi.org/10.1007/s00595-011-0114-4

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