Optimal Extent of Lymph Node Dissection for Siewert Type II Esophagogastric Junction Adenocarcinoma
Optimal Extent of Lymph Node Dissection for Siewert Type II Esophagogastric Junction Adenocarcinoma
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DOI：
10.1016/j.athoracsur.2015.02.075
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发表时间：
2015-07-01
影响因子：
4.6
通讯作者：
Chen, Long-Qi
中科院分区：
文献类型：
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作者：
Peng, Jun;Wang, Wen-Ping;Chen, Long-Qi
背景食管胃交界处Siewert II型腺癌（AEG）的最佳手术入路和淋巴结清扫范围存在争议。本研究的目的是确定胸、腹淋巴结清扫的最佳范围以及适当的手术入路。方法。回顾性分析了2007年1月至2011年10月期间收治的192例Siewert II型AEG患者的临床病理资料。采用淋巴结清扫的估计受益指数评价各站淋巴结清扫的治疗价值。总的来说，对于胸淋巴结清扫，左胸路径和Ivor-Lewis手术比腹经裂孔路径更好。对于腹部淋巴结清扫，经腹淋巴结清扫术的清扫范围较好。除第16站外，各站转移率差异无统计学意义。多因素分析发现，只有N分期（p = 0.000）和切除淋巴结数量为12个或更多（p = 0.035）是Siewert II型AEG的预后因素。此外，我们确定了2个胸淋巴结（8 M和8L）和6个腹淋巴结（16、17、19、20、G3、G4），对患者具有较高的治疗价值。我们建议Siewert II型AEG应切除8 M、8L、16、17和G3。考虑到淋巴结清扫，Ivor-Lewis手术是Siewert II型AEG患者的最佳选择。(C)2015年美国胸外科医师协会
Background. The optimal surgical approach and extent of lymphadenectomy for Siewert type II adenocarcinoma of the esophagogastric junction (AEG) is controversial. The aim of this study was to identify its optimal extent of thoracic and abdominal lymph node dissection, and the appropriate surgical approach.Methods. The clinicopathologic data of 192 patients with Siewert type II AEG who were admitted to our center during January 2007 through October 2011 were retrospectively analyzed. We used the index of estimated benefit from lymph node dissection to assess the therapeutic value of lymph node dissection of each station.Results. Overall, for the thoracic lymph node dissection, the left thoracic route and Ivor-Lewis procedure are better choices than the abdominotranshiatal route. While for the abdominal lymph node dissection, the abdominotranshiatal achieved a better dissection extent. No significant difference was found in metastatic frequency for each station except the 16th station. The multivariate analysis found only N stage (p = 0.000) and number of resected lymph nodes of 12 or more (p = 0.035) were prognostic factors for Siewert type II AEG. Furthermore, we identified two thoracic lymph node stations (8M and 8L) and six abdominal lymph node stations (16, 17, 19, 20, G3, G4) that have a high therapeutic value for the patients.Conclusions. We recommend the 8M, 8L, 16, 17, and G3 should be excised for Siewert type II AEG. Considering the lymphadenectomy, the Ivor-Lewis procedure is the optimal choice for patients with Siewert type II AEG. (C) 2015 by The Society of Thoracic Surgeons