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Pattern of lymph node dissemination from adenocarcinoma of the oesophagogastric junction. BJS 1999; 86: 424-424.

Published: 2nd January 2003

Authors: S. M. Dresner, J. Wayman, M. K. Bennett, N. Hayes, S. M. Griffin

Background

Adenocarcinoma of the oesophagogastric junction (OGJ) is rapidly increasing in incidence and the role of radical lymphadenectomy for such tumours remains controversial. The aim of this study was to identify the pattern of metastatic nodal spread by histopathological assessment of all lymph node groups retrieved from resected specimens.

Method

Data were collected prospectively from patients undergoing potentially curative (R0) resection with lymphadenectomy for adenocarcinoma of the OGJ between January 1996 and May 1998. Patients with type 1 tumours (lower third of the oesophagus) underwent two‐stage subtotal oesophagogastrectomy with two‐tier lymphadenectomy. Patients with type 2 (gastric cardia) tumours underwent D2 total gastrectomy. At the time of surgery all lymph node groups were dissected out from the specimens, labelled and assessed by a single consultant histopathologist.

Results

A total of 103 patients were studied. Eleven patients were understaged before operation and were inoperable or had palliative resections. Of the remaining 92 patients, 68 had type 1 tumours and 24 had type 2 tumours. Some 2301 nodes were analysed representing a median of 27 nodes per patient (26 from the oesophagectomy group and 30 from the gastrectomy group). Over 70 per cent of all patients had lymph node metastases at the time of surgery. Some 6 per cent of type 1 tumours with lymph node metastases had dissemination in both the abdominal and mediastinal nodal tiers. The common abdominal sites were the paracardial (right, 23 of 41; left, 23 of 41) and left gastric nodes (29 of 41) whereas within the mediastinum paraoesophageal (25 of 41) and bronchial (right, seven of 41; left, six of 41) metastases were more often encountered. Type 2 tumours had positive lymph nodes most frequently in the left paracardial (nine of 16), lesser curve (11 of 16) (N1 group) and left gastric (eight of 16) (N2 group) territories. The extent of lymph node positivity correlated with the T stage and differentiation of the primary tumour, as well as the presence of perineural, lymphatic and vascular invasion (P < 0·05).

Conclusion

The high incidence and widespread dissemination of nodal metastases at the time of surgery seen with these tumours may justify the approach of systematic lymphadenectomy in the hope of performing a curative resection. The current definition of the lymph node sites in the abdominal and mediastinal tiers for type 1 tumours is based on experience with lower‐third squamous carcinomas. These results demonstrate a different pattern of dissemination for junctional␣oesophageal adenocarcinomas requiring redefinition of the nodal stations to be resected in radical lymphadenectomies for such tumours. © 1999 British Journal of Surgery Society Ltd

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