Abstract
Background
The purpose of this study was to evaluate the prognosis of patients with Siewert type
II/III adenocarcinoma of the esophagogastric junction (AEG) with parapyloric lymph
node (No. 5 and 6 lymph nodes, PLN) metastasis and to determine the need for PLN dissection
for patients with type II/III AEG.
Methods
A total of 1008 patients with type II/III AEG who underwent a transabdominal total
gastrectomy were enrolled. The long-term surgical outcome of PLN-positive patients
and the therapeutic value of PLN dissection were analyzed.
Results
There was no significant difference in the incidence of PLN metastasis between type
II and III cancers (5.7% vs. 8.5%, P > 0.05). PLN metastasis was a significant prognostic
factor for type II/III cancers (HR 1.63; P = 0.001). Among type II/III cancers, the
5-year survival of patients with PLN-positive cancers was much lower than that of
patients with PLN-negative cancers (21.3% vs. 60.8%, P < 0.001). Even after radical
resection, the 5-year survival of patients with stage I–III PLN-positive cancers was
similar to that of patients with stage IV cancers without PLN metastasis (23.5% vs.
23.1%, P > 0.05). In the analysis of the therapeutic value of lymph node dissection
in each station for type II and III cancers after radical resection, lymph nodes with
the lowest therapeutic value index after No. 12a were No. 5 and 6 lymph nodes.
Conclusions
Patients with type II/III AEG with PLN metastasis have a poor prognosis, similar to
patients with stage IV disease. PLN dissection offers marginal therapeutic value for
patients with type II/III AEG.
Keywords
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Article info
Publication history
Published online: September 08, 2017
Accepted:
August 25,
2017
Identification
Copyright
© 2017 Elsevier Ltd, BASO ~ The Association for Cancer Surgery, and the European Society of Surgical Oncology. All rights reserved.
