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Benefit of mediastinal and para‐aortic lymph‐node dissection for advanced gastric cancer with esophageal invasion
Author(s) -
Nunobe Souya,
Ohyama Shigekazu,
Sonoo Hiroshi,
Hiki Naoki,
Fukunaga Tetsu,
Seto Yasuyuki,
Yamaguchi Toshiharu
Publication year - 2008
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.20987
Subject(s) - medicine , dissection (medical) , lymph , esophageal cancer , lymph node , metastasis , mediastinal lymph node , radiology , cancer , mediastinum , esophagus , surgery , pathology
Background and Objectives Lymph‐node dissection in gastric cancers with esophageal invasion (AGCE) is of current interest. This study examined the significance of inferior mediastinal lymph‐node (IM) and para‐aortic lymph‐node (PA) dissection for this type of cancer. Method Two hundred and seventy cases of AGCE were clinicopathologically reviewed. An index of estimated benefit from lymph‐node dissection (IEBLD) was calculated from the frequency of lymph node metastasis in IM and PA, and from 5‐year survival rates for metastatic cases. Results Among the cases of AGCE, IM and PA metastasis rates were 18.1% and 22.2%, respectively. The IEBLD for IM and PA was similar to that for dissection of the second‐tier lymph nodes around the celiac axis. The IM metastasis rate was 0.0% for esophageal invasion of 0–9 mm, 2.2% for 10–19 mm, 17.8% for 20–29 mm, and 21.7% for 30–39 mm of esophageal invasion. Conclusion AGCE is associated with a high rate of PA metastasis, and with a high rate of IM metastasis when esophageal invasion exceeds 2 cm. Since dissection of IM and PA achieved the same benefit as dissection of second‐tier lymph nodes, we recommend thorough dissection of these lymph nodes. J. Surg. Oncol. 2008;97:392–395. © 2008 Wiley‐Liss, Inc.