The 7th Joint Session between JDDW-KDDW-TDDW2(JDDW)
Thu. November 2nd   14:00 - 17:00   Room 9: Portopia Hotel Main Building Kairaku 3
Approach and therapeutic value index for Siewert type 2 esophagogastric junction adenocarcinoma
Eisuke Booka1, Hirotoshi Kikuchi1, Hiroya Takeuchi1
1Department of Surgery, Hamamatsu University School of Medicine
[Background] Based on the metastasis rate from a prospective observational study on esophagogastric junction adenocarcinoma, the range of lymph node dissection and the surgical approach are recommended according to esophageal involvement, however the therapeutic value index is unclear.
[Patients and Methods] From January 2016 to June 2022, 55 patients who underwent surgery for Siewert type 2 esophagogastric junction adenocarcinoma were investigated for the metastasis rate of mediastinal/abdominal lymph nodes, therapeutic value index = metastasis rate * 5-year OS rate in patients with metastasis, and short-term outcomes of right thoracic / transhiatal approach.
[Results] When divided into 41 cases of the right thoracic approach (Group A) and 14 cases of the transhiatal approach (Group B), tumor size (50mm vs 24mm) and esophageal involvement (30mm vs 12.5mm) were significantly longer in Group A. The degree of progression (cStage1/2/3/4) was significantly higher in Group A (7/6/26/2) compared to Group B (5/7/2/0). The operation time (524 minutes vs 359 minutes) and blood loss (215ml vs 75ml) were significantly less in Group B, however there was no significant difference in pneumonia (9.8% vs 7.1%), anastomotic leakage (9.8% vs 0%), and pancreatic fistula (2.4% vs 0%) between the two groups. The therapeutic value index was #1 (18.7), #2 (26.4), #3a (20.3), #7 (21.0), #8a (0), #9 (11.4), #11p (4.2), #110 (8.5), #105 (0), #106recR (0), #108 (0), with the therapeutic value being high for abdominal lymph nodes (#1, #2, #3a, #7, #9) and lower mediastinal lymph nodes (#110), however the therapeutic value was low for #8a, #11p and upper mediastinal lymph nodes.
[Conclusion] For Siewert type 2 esophagogastric junction adenocarcinoma, the therapeutic value of upper mediastinal lymph nodes dissection is low, and adequate lymph node dissection of the abdomen and lower mediastinum and safe reconstruction according to the esophageal involvement are desirable.
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