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International Session (Symposium)3 (JSGS・JSGE・JGES)
Fri. October 13th   14:00 - 17:00   Room 1: Fukuoka Kokusai Center Arena
Optimal surgical approach for the esophagogastric junction cancer
H. Takeuchi1,2, Y. Kitagawa2
1Department of Surgery, Hamamatsu University School of Medicine, 2Department of Surgery, Keio University School of Medicine
Purpose: Optimal extent of mediastinal lymph node dissection for esophagogastric junction (EGJ) cancer remains controversial. The aim of this study was to clarify the EGJ cancer patients who were at high risk for upper and middle mediastinal lymph node metastasis. Methods: This retrospective study included 127 consecutive patients with EGJ carcinoma (Nishi's classification).who underwent R0/R1 resection in our institution. Results: Of the 127 patients, 21 (16.5%) had mediastinal lymph node (MLN) metastasis or recurrence. Patients in whom the tumor epicenter was located above the EGJ had a significantly higher incidence (33%) of MLN metastasis or recurrence than those whose epicenter was located below the EGJ. In addition, the rate of MLN metastasis or recurrence was particularly high when the distance from the EGJ to the proximal edge of the primary tumor was more than 3 cm for the upper and middle mediastinum (22.2%) and more than 2 cm for the lower mediastinum (21.1%). In particular, patients in a selected group (T2 or more and tumor epicenter located above the EGJ or below the EGJ with more than 3 cm esophageal invasion) showed 35.6% as upper and middle MLN metastasis or recurrence rates, and the rate of total MLN metastasis or recurrence was 46.7%. Conclusions: The tumor epicenter, T factor and esophageal invasion of EGJ cancer should be considered for optimal surgical approach.
Index Term 1: esophagogastric junction
Index Term 2: surgery
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