Lymphogenic metastasis (LM) firstly develops in lymph nodes (LNs) along the antegrade lymph flow (LF) from the primary cancer site. Development of retrograde LF and metastases in LNs along that might be a more advanced stage of the LM. Siewert's type II EGJ adenocarcinoma (AC) has a unique pattern of LM differing from that seen with gastric and esophageal carcinoma. We hypothesize that the LN station 8 is not on the antegrade LF from Siewert's type II EGJ AC and its metastatic damage can impact negatively on the prognosis following radical surgery.
This is a retrospective study on 174 (m – 131, f – 43) consecutive patients (pts) with Siewert's type II EGJ AC of T2-T4b stages who had undergone radical surgery from January 2001 till December 2015 by our surgical team. 142 pts underwent extended total gastrectomy by transhiatal access. In all 142 pts the surgery was completed by D2 plus low mediastinal LN dissection. For homogeneity of compared subgroups, only the pts who had undergone extended total gastrectomy and received adjuvant chemotherapy (103 pts) were enrolled into the study. The T stages according to 7th Edition of AJCC/UICC guidelines of tumors were as following: T2 – 4 (3.9%); T3 – 35 (34.0%), T4a – 50 (48.5%) and T4b – 14 (13.6%). 5-year survival rates were analyzed comparatively in pts with (arm 1) and without metastases (arm 2) in LN station 8. The survival of the pts was calculated by the Kaplan-Meier method. The difference between the survival rates was assessed by means of the long-rank test. P
Metastases in the LN station 8 were detected in 19 pts: 1 (2.8%) in T3 stage, 12 (24.0%) - in T4a stage and 6 (42.8%) - in T4b stage (p
Metastases in LN station 8 is a negative prognostic factor in Siewert's type II EGJ AC and should be taken into account when planning treatment strategy.
Clinical trial identification
Legal entity responsible for the study
Azerbaijan Medical University
All authors have declared no conflicts of interest.