Pattern of abdominal nodal spread and optimal abdominal lymphadenectomy for advanced Siewert type II adenocarcinoma of the cardia: Results of a multicenter study

Kazumasa Fujitani, Isao Miyashiro, Shoki Mikata, Shigeyuki Tamura, Hiroshi Imamura, Johji Hara, Yukinori Kurokawa, Jyunya Fujita, Kazuhiro Nishikawa, Yutaka Kimura, Shuji Takiguchi, Masaki Mori, Yuichiro Doki

Research output: Contribution to journalArticle

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Abstract

Background: It remains uncertain whether radical lymphadenectomy combined with total gastrectomy actually contributes to long-term survival for Siewert type II adenocarcinoma of the cardia. We identified the pattern of abdominal nodal spread in advanced type II adenocarcinoma and defined the optimal extent of abdominal lymphadenectomy. Methods: Eighty-six patients undergoing R0 total gastrectomy for advanced type II adenocarcinoma were identified from the gastric cancer database of 4,884 patients. Prognostic factors were investigated by multivariate analysis. The therapeutic value of lymph node dissection for each station was estimated by multiplying the incidence of metastasis by the 5-year survival rate of patients with positive nodes in each station. Results: The overall 5-year survival rate was 37.1 %. Age less than 65 years [hazard ratio, 0.455 (95 % confidence interval (CI), 0.261-0.793)] and nodal involvement with pN3 as referent [hazard ratio for pN0, 0.129 (95 % CI, 0.048-0.344); for pN1, 0.209 (95 % CI, 0.097-0.448); and for pN2, 0.376 (95 % CI, 0.189-0.746)] were identified as significant prognosticators for longer survival. Perigastric nodes of the lower half of the stomach in positions 4d-6 were considered not beneficial to dissect, whereas there were substantial therapeutic benefits to dissecting the perigastric nodes of the upper half of the stomach in positions 1-3 and the second-tier nodes in positions 7 and 11. Conclusions: Limited lymphadenectomy attained by proximal gastrectomy might suffice as an alternative to extended lymphadenectomy with total gastrectomy for obtaining potential therapeutic benefit in abdominal lymphadenectomy for advanced Siewert type II adenocarcinoma.

Original languageEnglish
Pages (from-to)301-308
Number of pages8
JournalGastric Cancer
Volume16
Issue number3
DOIs
Publication statusPublished - Jul 1 2013

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Cardia
Lymph Node Excision
Multicenter Studies
Adenocarcinoma
Gastrectomy
Confidence Intervals
Stomach
Survival Rate
Survival
Stomach Neoplasms
Therapeutics
Multivariate Analysis
Databases
Neoplasm Metastasis
Incidence

All Science Journal Classification (ASJC) codes

  • Oncology
  • Gastroenterology
  • Cancer Research

Cite this

Pattern of abdominal nodal spread and optimal abdominal lymphadenectomy for advanced Siewert type II adenocarcinoma of the cardia : Results of a multicenter study. / Fujitani, Kazumasa; Miyashiro, Isao; Mikata, Shoki; Tamura, Shigeyuki; Imamura, Hiroshi; Hara, Johji; Kurokawa, Yukinori; Fujita, Jyunya; Nishikawa, Kazuhiro; Kimura, Yutaka; Takiguchi, Shuji; Mori, Masaki; Doki, Yuichiro.

In: Gastric Cancer, Vol. 16, No. 3, 01.07.2013, p. 301-308.

Research output: Contribution to journalArticle

Fujitani, K, Miyashiro, I, Mikata, S, Tamura, S, Imamura, H, Hara, J, Kurokawa, Y, Fujita, J, Nishikawa, K, Kimura, Y, Takiguchi, S, Mori, M & Doki, Y 2013, 'Pattern of abdominal nodal spread and optimal abdominal lymphadenectomy for advanced Siewert type II adenocarcinoma of the cardia: Results of a multicenter study', Gastric Cancer, vol. 16, no. 3, pp. 301-308. https://doi.org/10.1007/s10120-012-0183-0
Fujitani, Kazumasa ; Miyashiro, Isao ; Mikata, Shoki ; Tamura, Shigeyuki ; Imamura, Hiroshi ; Hara, Johji ; Kurokawa, Yukinori ; Fujita, Jyunya ; Nishikawa, Kazuhiro ; Kimura, Yutaka ; Takiguchi, Shuji ; Mori, Masaki ; Doki, Yuichiro. / Pattern of abdominal nodal spread and optimal abdominal lymphadenectomy for advanced Siewert type II adenocarcinoma of the cardia : Results of a multicenter study. In: Gastric Cancer. 2013 ; Vol. 16, No. 3. pp. 301-308.
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T1 - Pattern of abdominal nodal spread and optimal abdominal lymphadenectomy for advanced Siewert type II adenocarcinoma of the cardia

T2 - Results of a multicenter study

AU - Fujitani, Kazumasa

AU - Miyashiro, Isao

AU - Mikata, Shoki

AU - Tamura, Shigeyuki

AU - Imamura, Hiroshi

AU - Hara, Johji

AU - Kurokawa, Yukinori

AU - Fujita, Jyunya

AU - Nishikawa, Kazuhiro

AU - Kimura, Yutaka

AU - Takiguchi, Shuji

AU - Mori, Masaki

AU - Doki, Yuichiro

PY - 2013/7/1

Y1 - 2013/7/1

N2 - Background: It remains uncertain whether radical lymphadenectomy combined with total gastrectomy actually contributes to long-term survival for Siewert type II adenocarcinoma of the cardia. We identified the pattern of abdominal nodal spread in advanced type II adenocarcinoma and defined the optimal extent of abdominal lymphadenectomy. Methods: Eighty-six patients undergoing R0 total gastrectomy for advanced type II adenocarcinoma were identified from the gastric cancer database of 4,884 patients. Prognostic factors were investigated by multivariate analysis. The therapeutic value of lymph node dissection for each station was estimated by multiplying the incidence of metastasis by the 5-year survival rate of patients with positive nodes in each station. Results: The overall 5-year survival rate was 37.1 %. Age less than 65 years [hazard ratio, 0.455 (95 % confidence interval (CI), 0.261-0.793)] and nodal involvement with pN3 as referent [hazard ratio for pN0, 0.129 (95 % CI, 0.048-0.344); for pN1, 0.209 (95 % CI, 0.097-0.448); and for pN2, 0.376 (95 % CI, 0.189-0.746)] were identified as significant prognosticators for longer survival. Perigastric nodes of the lower half of the stomach in positions 4d-6 were considered not beneficial to dissect, whereas there were substantial therapeutic benefits to dissecting the perigastric nodes of the upper half of the stomach in positions 1-3 and the second-tier nodes in positions 7 and 11. Conclusions: Limited lymphadenectomy attained by proximal gastrectomy might suffice as an alternative to extended lymphadenectomy with total gastrectomy for obtaining potential therapeutic benefit in abdominal lymphadenectomy for advanced Siewert type II adenocarcinoma.

AB - Background: It remains uncertain whether radical lymphadenectomy combined with total gastrectomy actually contributes to long-term survival for Siewert type II adenocarcinoma of the cardia. We identified the pattern of abdominal nodal spread in advanced type II adenocarcinoma and defined the optimal extent of abdominal lymphadenectomy. Methods: Eighty-six patients undergoing R0 total gastrectomy for advanced type II adenocarcinoma were identified from the gastric cancer database of 4,884 patients. Prognostic factors were investigated by multivariate analysis. The therapeutic value of lymph node dissection for each station was estimated by multiplying the incidence of metastasis by the 5-year survival rate of patients with positive nodes in each station. Results: The overall 5-year survival rate was 37.1 %. Age less than 65 years [hazard ratio, 0.455 (95 % confidence interval (CI), 0.261-0.793)] and nodal involvement with pN3 as referent [hazard ratio for pN0, 0.129 (95 % CI, 0.048-0.344); for pN1, 0.209 (95 % CI, 0.097-0.448); and for pN2, 0.376 (95 % CI, 0.189-0.746)] were identified as significant prognosticators for longer survival. Perigastric nodes of the lower half of the stomach in positions 4d-6 were considered not beneficial to dissect, whereas there were substantial therapeutic benefits to dissecting the perigastric nodes of the upper half of the stomach in positions 1-3 and the second-tier nodes in positions 7 and 11. Conclusions: Limited lymphadenectomy attained by proximal gastrectomy might suffice as an alternative to extended lymphadenectomy with total gastrectomy for obtaining potential therapeutic benefit in abdominal lymphadenectomy for advanced Siewert type II adenocarcinoma.

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