Advertisement

Should the splenic hilar lymph node be dissected for the management of adenocarcinoma of the esophagogastric junction?

      Abstract

      Background

      Splenic hilar lymphadenectomy is not recommended for advanced proximal gastric cancer that does not invade the greater curvature according to the results of the previous studies. The efficacy of splenic hilar lymphadenectomy for type II and type III adenocarcinomas of the esophagogastric junction and easy spread to the greater curvature of the stomach remains unclear. This study aimed to investigate the efficacy of splenic hilar lymphadenectomy and identify the risk factors for metastasis to splenic hilar nodes.

      Methods

      We examined patients who underwent R0/1 gastrectomy for Siewert types II and III at a single high–volume center in Japan. We analyzed the metastatic incidence, therapeutic value index, and risk factors for splenic hilar lymph node metastasis.

      Results

      We examined 126 patients (74, type II; 52, type III). Splenectomy was performed in 76 patients. Metastatic incidence and the therapeutic value index of splenic hilar lymph nodes in patients with type II and type III tumors were 4.5% and 0, and 21.9% and 9.4, respectively. In the patients who underwent splenectomy, we identified Siewert type III tumors (odds ratio: 6.93, 95% confidence interval: 1.24–38.8, p = 0.027) and tumor location other than the lesser curvature (odds ratio: 7.36, 95% confidence interval: 1.32–41.1, p = 0.023) to be independent risk factors. The metastatic incidence (46.2%) and therapeutic value index (15.4) were high in patients with both risk factors.

      Conclusions

      Splenic hilar lymphadenectomy may contribute to the survival of patients with Siewert type III tumors, especially when the predominant location is not the lesser curvature.

      Keywords

      To read this article in full you will need to make a payment

      Purchase one-time access:

      Academic & Personal: 24 hour online accessCorporate R&D Professionals: 24 hour online access
      One-time access price info
      • For academic or personal research use, select 'Academic and Personal'
      • For corporate R&D use, select 'Corporate R&D Professionals'

      Subscribe:

      Subscribe to European Journal of Surgical Oncology
      Already a print subscriber? Claim online access
      Already an online subscriber? Sign in
      Institutional Access: Sign in to ScienceDirect

      References

        • Hasegawa S.
        • Yoshikawa T.
        Adenocarcinoma of the esophagogastric junction: incidence, characteristics, and treatment strategies.
        Gastric Cancer. 2010; 13: 63-73https://doi.org/10.1007/s10120-010-0555-2
        • Siewert J.R.
        • Stein H.J.
        Classification of adenocarcinoma of the oesophagogastric junction.
        Br J Surg. 1998; 85: 1457-1459https://doi.org/10.1046/j.1365-2168.1998.00940.x
        • Mariette C.
        • Piessen G.
        • Briez N.
        • Gronnier C.
        • Triboulet J.P.
        Oesophagogastric junction adenocarcinoma: which therapeutic approach?.
        Lancet Oncol. 2011; 12: 296-305https://doi.org/10.1016/s1470-2045(10)70125-x
        • Takahashi T.
        • Sawai K.
        • Hagiwara A.
        • Takahashi S.
        • Seiki K.
        • Tokuda H.
        Type-oriented therapy for gastric cancer effective for lymph node metastasis: management of lymph node metastasis using activated carbon particles adsorbing an anticancer agent.
        Semin Surg Oncol. 1991; 7: 378-383https://doi.org/10.1002/ssu.2980070610
        • Nakagawa N.
        Rationale for dissection of lymph node associated with gastric carcinoma located at the greater curvature of the stomach—the correlation between the pattern of lymph node metastasis and the distribution of blackened lymph nodes by vital staining using activated carbon particles (CH40) (in Japanese with English abstract).
        Nihon Syokakigeka Gakkaizasshi (Jpn J Gastroenterol Surg). 1992; 25: 2460-2469https://doi.org/10.5833/jjgs.25.2460
        • Brar S.S.
        • Seevaratnam R.
        • Cardoso R.
        • Law C.
        • Helyer L.
        • Coburn N.
        A systematic review of spleen and pancreas preservation in extended lymphadenectomy for gastric cancer.
        Gastric Cancer. 2012; 15: S89-S99https://doi.org/10.1007/s10120-011-0087-4
        • Sano T.
        • Sasako M.
        • Mizusawa J.
        • Yamamoto S.
        • Katai H.
        • Yoshikawa T.
        • et al.
        Randomized controlled trial to evaluate splenectomy in total gastrectomy for proximal gastric carcinoma.
        Ann Surg. 2017; 265: 277-283https://doi.org/10.1097/sla.0000000000001814
        • Kurokawa Y.
        • Takeuchi H.
        • Doki Y.
        • Mine S.
        • Terashima M.
        • Yasuda T.
        • et al.
        Mapping of lymph node metastasis from esophagogastric junction tumors: a prospective nationwide multicenter study.
        Ann Surg. 2021; 274: 120-127https://doi.org/10.1097/sla.0000000000003499
        • Watanabe M.
        • Kinoshita T.
        • Enomoto N.
        • Shibasaki H.
        • Nishida T.
        Clinical significance of splenic hilar dissection with splenectomy in advanced proximal gastric cancer: an analysis at a single institution in Japan.
        World J Surg. 2016; 40: 1165-1171https://doi.org/10.1007/s00268-015-3362-4
        • Maezawa Y.
        • Aoyama T.
        • Yamada T.
        • Kano K.
        • Hayashi T.
        • Sato T.
        • et al.
        Priority of lymph node dissection for proximal gastric cancer invading the greater curvature.
        Gastric Cancer. 2018; 21: 569-572https://doi.org/10.1007/s10120-017-0775-9
        • Yura M.
        • Yoshikawa T.
        • Otsuki S.
        • Yamagata Y.
        • Morita S.
        • Katai H.
        • et al.
        The therapeutic survival benefit of splenic hilar nodal dissection for advanced proximal gastric cancer invading the greater curvature.
        Ann Surg Oncol. 2019; 26: 829-835https://doi.org/10.1245/s10434-018-07122-9
        • Sasako M.
        • Sano T.
        • Yamamoto S.
        • Sairenji M.
        • Arai K.
        • Kinoshita T.
        • et al.
        Left thoracoabdominal approach versus abdominal-transhiatal approach for gastric cancer of the cardia or subcardia: a randomised controlled trial, the Lancet.
        Oncology. 2006; 7: 644-651https://doi.org/10.1016/s1470-2045(06)70766-5
        • Brierley J.
        • Gospodarowicz M.
        • Wittekind C.
        TNM classification of malignant tumors.
        eighth ed. Wiley-Blackwell, New York2016
        • Association J.G.C.
        Japanese classification of gastric carcinoma.
        3rd English edition. 14. Gastric Cancer, 2011: 101-112https://doi.org/10.1007/s10120-011-0041-5
        • Nakajima T.
        Gastric cancer treatment guidelines in Japan.
        Gastric Cancer. 2002; 5: 1-5
        • Association J.G.C.
        Japanese gastric cancer treatment guidelines 2010 (ver. 3).
        Gastric Cancer. 2011; 14: 113-123https://doi.org/10.1007/s10120-011-0042-4
        • Association J.G.C.
        Japanese gastric cancer treatment guidelines 2014 (ver. 4).
        Gastric Cancer. 2017; 20: 1-19https://doi.org/10.1007/s10120-016-0622-4
        • 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