Matsuda Tatsuo, Takeuchi Hiroya, Tsuwano Shinichi, Nakamura Rieko, Takahashi Tsunehiro, Wada Norihito, Kawakubo Hirofumi, Saikawa Yoshiro, Omori Tai, Kitagawa Yuko
Department of Surgery, Keio University School of Medicine, 35 Shinanomachi, Shinjuku-ku, Tokyo, 160-8582, Japan.
Gen Thorac Cardiovasc Surg. 2014 Sep;62(9):560-6. doi: 10.1007/s11748-014-0381-2. Epub 2014 Feb 26.
Esophagogastric junction carcinoma incidence is increasing worldwide. However, surgical strategies for this cancer remain controversial. This study aimed to clarify the optimal surgical strategy for esophagogastric junction carcinoma.
We retrospectively reviewed a database of 68 consecutive patients with esophagogastric junction carcinoma [Japanese classification of gastric carcinoma (Nishi's definition): adenocarcinoma, N=53; squamous cell carcinoma, N=15] who underwent curative surgical resection at Keio University Hospital between January 2000 and September 2008.
In both adenocarcinoma and squamous cell carcinoma, most lymph node metastases were located in the lesser curvature area. Mediastinal lymph node metastasis was observed in 4 patients (7.5%) with adenocarcinoma and 7 patients (46.7%) with squamous cell carcinoma. No patient presented with lymph node metastases in the pyloric region. The therapeutic value of extended lymph node dissection was 0, except for lymph node station numbers 1, 2, 3, 4sa, 7, and 110. Extended lymph node dissection in the lesser curvature area showed a high therapeutic value. The para-aortic lymph node was the most frequent nodal recurrence site. All patients with tumor centers located below the esophagogastric junction (N=37) did not develop mediastinal lymph node metastasis or recurrence.
Proximal gastrectomy through a transhiatal approach may be the optimal surgical strategy for esophagogastric carcinoma. Mediastinal lymph node dissection through a thoracic approach seems unnecessary, particularly when the tumor center is located below the esophagogastric junction. To confirm the necessity of para-aortic nodal dissection, further studies are required.
食管胃交界部癌在全球的发病率正在上升。然而，针对这种癌症的手术策略仍存在争议。本研究旨在阐明食管胃交界部癌的最佳手术策略。
我们回顾性分析了2000年1月至2008年9月间在庆应义塾大学医院接受根治性手术切除的68例连续食管胃交界部癌患者的数据库[日本胃癌分类（西氏定义）：腺癌，N = 53；鳞状细胞癌，N = 15]。
在腺癌和鳞状细胞癌中，大多数淋巴结转移均位于小弯侧区域。4例（7.5%）腺癌患者和7例（46.7%）鳞状细胞癌患者出现纵隔淋巴结转移。无患者出现幽门区域淋巴结转移。除第1、2、3、4sa、7和110组淋巴结外，扩大淋巴结清扫的治疗价值为0。小弯侧区域的扩大淋巴结清扫显示出较高的治疗价值。主动脉旁淋巴结是最常见的淋巴结复发部位。所有肿瘤中心位于食管胃交界部以下的患者（N = 37）均未发生纵隔淋巴结转移或复发。
经裂孔途径近端胃切除术可能是食管胃癌的最佳手术策略。经胸途径进行纵隔淋巴结清扫似乎没有必要，特别是当肿瘤中心位于食管胃交界部以下时。为证实主动脉旁淋巴结清扫的必要性，还需要进一步研究。
