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High-risk group of upper and middle mediastinal lymph node metastasis in patients with esophagogastric junction carcinoma.

ABSTRACT: Aim:The aim of the present study was to clarify esophagogastric junction (EGJ) carcinoma patients who are at high risk of upper and middle mediastinal lymph node (MLN) metastasis. Methods:This was a retrospective study and included 110 consecutive patients with EGJ carcinoma who underwent R0/R1 resection at Keio University Hospital between January 2000 and December 2013. Results:Of the 110 patients, 18 (16.3%) had MLN metastasis, and the number increased to 23 (20.9%) when recurrence cases were added (adenocarcinoma, N = 11; squamous cell carcinoma, N = 12). Patients whose tumor epicenter was located above the EGJ had a significantly higher incidence of MLN metastasis/recurrence (18/51 [35.3%]) than those whose tumor epicenter was located below the EGJ (5/59 [8.5%]). The MLN metastasis/recurrence rate was particularly high when the distance from the EGJ to the proximal edge of the primary tumor was >3 cm for the upper and middle mediastinum (18.8%). Patients in a selected group (?T2 and tumor epicenter located above the EGJ or below the EGJ with ?3 cm esophageal invasion) showed 17.9% and 15.4% upper and middle MLN metastasis/recurrence rates, respectively. Therapeutic value of MLN dissection was relatively high (#105 + 106: 8.9, #110: 12.2). Conclusions:Therapeutic value of MLN dissection to treat EGJ carcinomas was relatively high in patients with MLN metastasis. Our algorithm could select patients at high risk for MLN metastasis.

SUBMITTER: Yura M

PROVIDER: S-EPMC6236104 | biostudies-literature | 2018 Nov

REPOSITORIES: biostudies-literature

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High-risk group of upper and middle mediastinal lymph node metastasis in patients with esophagogastric junction carcinoma.

Yura Masahiro M Takeuchi Hiroya H Fukuda Kazumasa K Nakamura Rieko R Suda Koichi K Wada Norihito N Kawakubo Hirofumi H Kitagawa Yuko Y

Annals of gastroenterological surgery 20181013 6

<h4>Aim</h4>The aim of the present study was to clarify esophagogastric junction (EGJ) carcinoma patients who are at high risk of upper and middle mediastinal lymph node (MLN) metastasis.<h4>Methods</h4>This was a retrospective study and included 110 consecutive patients with EGJ carcinoma who underwent R0/R1 resection at Keio University Hospital between January 2000 and December 2013.<h4>Results</h4>Of the 110 patients, 18 (16.3%) had MLN metastasis, and the number increased to 23 (20.9%) when ...[more]

PMID: 30460345

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Project description:BackgroundThe current preferred approach for surgical mediastinal staging of non-small-cell lung carcinoma is video-assisted mediastinoscopy. An alternative technique in which lymph nodes are resected instead of biopsied is video-assisted mediastinoscopic lymphadenectomy (VAMLA) that is suggested to be superior in detecting N2 disease. Yet, evidence is conflicting and furthermore limited by sample size. The objective was to compare mediastinal staging through VAMLA and video-assisted mediastinoscopy.MethodsA single-center cohort study was conducted. All consecutive patients that underwent surgical mediastinal staging of non-small-cell lung carcinoma by VAMLA (2011 to 2018) were compared to historic video-assisted mediastinoscopy controls (2007 to 2011). Patients with negative surgical mediastinal staging underwent subsequent anatomical resection with systematic regional lymphadenectomy. Primary outcome was the sensitivity and negative predictive value for detecting N2 disease.ResultsTwo-hundred-sixty-nine video-assisted mediastinoscopic lymphadenectomies and 118 video-assisted mediastinoscopies were performed. The prevalence of N2 disease was 20% and 26% respectively in the VAMLA and video-assisted mediastinoscopy group, while the rate of unforeseen pN2 resulting from lymph node dissection during anatomical resection was 4% and 11%, respectively. Invasive staging using VAMLA demonstrated superior sensitivity of 0.82 and a negative predictive value of 0.96 when compared to video-assisted mediastinoscopy (0.62 and 0.89, respectively), offering a 64% decrease in risk of unforeseen pN2 following anatomical resection. However, VAMLA is also associated with a 75% risk increase on complications (P=0.36).ConclusionsWe conclude that performing invasive mediastinal lymph node assessment for staging of non-small-cell lung carcinoma, VAMLA should be the preferred technique with superior sensitivity and negative predictive value in detecting N2 disease. Though, VAMLA is also associated with an increased risk of complications.

Dataset Information

High-risk group of upper and middle mediastinal lymph node metastasis in patients with esophagogastric junction carcinoma.

Publications

High-risk group of upper and middle mediastinal lymph node metastasis in patients with esophagogastric junction carcinoma.

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