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Lymphatic spread and microinvolvement in adenocarcinoma of the esophago‐gastric junction
Author(s) -
Schurr Paulus G.,
Yekebas Emre F.,
Kaifi Jussuf T.,
Lasch Steffi,
Strate Tim,
Kutup Asad,
Cataldegirmen Guel,
Bubenheim Michael,
Pantel Klaus,
Izbicki Jakob R.
Publication year - 2006
Publication title -
journal of surgical oncology
Language(s) - English
Resource type - Journals
SCImago Journal Rank - 1.201
H-Index - 111
eISSN - 1096-9098
pISSN - 0022-4790
DOI - 10.1002/jso.20582
Subject(s) - medicine , lymph , lymphadenectomy , adenocarcinoma , lymph node , esophagectomy , lymphatic system , gastrectomy , cancer , mediastinum , stomach , gastroenterology , esophageal cancer , surgery , pathology
Background Adenocarcinoma of the esophago‐gastric junction (EGJ) potentially spreads to abdominal and mediastinal lymph nodes. Methods Eighty‐five patients with type I and II EGJ cancer underwent curative esophagectomy or esophago‐gastrectomy and radical abdominal and mediastinal lymphadenectomy. Microinvolvement was detected with the mAb Ber‐Ep4 in all histopathologically free lymph nodes. Results In type I tumors (n = 40), lower mediastinal lymph nodes were positive in 24% and among type II tumors (n = 45) in 10% of patients. Ber‐Ep4+ cells in apparently free lymph nodes were found in 49% of patients. On inclusion of Ber‐Ep4+ nodes, positive mediastinal lymph node staging was rising to 40 and 33% in type I and II patients, respectively. After a median observation time of 27.1 months, 37 of 85 patients (43.5%) had died of tumor disease. Kaplan–Meier analysis revealed a significant impact of nodal microinvolvement on disease‐specific survival for type I and type II tumors ( P = 0.016 and P < 0.001, respectively). Cox regression analysis revealed a 2.77 higher independent risk ( P = 0.002) for nodal microinvolvement. Conclusions Lymphatic microinvolvement shows a high incidence in curatively resected EGJ cancer. Spread to mediastinal lymph nodes seems to necessitate lymphadenectomy of the thoracic cavity in either type. J. Surg. Oncol. 2006;94:307–315. © 2006 Wiley‐Liss, Inc.