Department of Surgery, Seoul National University College of Medicine, 101 Daehang-Ro, Jongno-gu, 110-744, Seoul, Korea.
Cancer Research Institute, Seoul National University College of Medicine, 101 Daehang-Ro, Jongno-gu, 110-744, Seoul, Korea.
Ann Surg Oncol. 2017 Nov;24(12):3631-3639. doi: 10.1245/s10434-017-6011-3. Epub 2017 Aug 21.
The surgical approach for adenocarcinoma of the esophagogastric junction (AEJ) still is controversial despite revised tumor-node-metastasis (TNM) classification. This study aimed to evaluate the oncologic outcome of a routine transhiatal approach for AEJ in terms of recurrence and lymph node (LN) metastasis of AEJ.
Recurrence patterns and LN metastasis of a single, primary AEJ (n = 463) treated by a surgical resection using a transhiatal approach without routine complete mediastinal LN dissection or routine splenectomy were analyzed respectively. To validate current treatment for recurrence, a validation index of recurrence (ViR; overall survival/incidence of solitary recurrence factor) was developed.
The overall recurrence rate for AEJ was 20.3%, which did not differ significantly between AEJ II (20.8%; n = 125) and AEJ III (20.1%; n = 338). Mediastinal recurrence did not differ significantly among the subtypes of AEJ, irrespective of gastroesophageal junction involvement. Splenic hilar LN recurrence-free survival did not differ significantly between the gastrectomy-only group, the gastrectomy-plus-splenectomy group, and the gastrectomy plus distal pancreatectomy group. The solitary recurrence rate for the mediastinal LN was 0.7% for AEJ, and the overall median survival with that recurrence was 30.5 months. The ViR for mediastinal LN recurrence (43.6) was higher than for regional LN (20.9) or distant LN (14.6) metastasis.
In terms of LN metastasis and recurrence, a transhiatal approach without complete mediastinal LN dissection can be acceptable, and routine splenectomy is not necessary for AEJ II or AEJ III arising within the stomach.
尽管肿瘤-淋巴结-转移（TNM）分期已经修订，但胃食管结合部腺癌（AEG）的手术方法仍存在争议。本研究旨在评估经胸入路治疗 AEG 的肿瘤学结果，特别是在 AEG 的局部复发和淋巴结（LN）转移方面。
分析了 463 例接受经胸入路手术切除的单一原发性 AEG 患者的复发模式和 LN 转移情况，该手术未常规进行全纵隔 LN 清扫或常规脾切除术。为了验证当前的治疗方法是否能预防复发，引入了复发验证指数（ViR；总生存率/单一复发因素的发生率）。
AEG 的总体复发率为 20.3%，AEG II （20.8%；n=125）和 AEG III （20.1%；n=338）之间无显著差异。纵隔复发与 AEG 亚型无关，无论胃食管结合部是否受累。脾门 LN 无复发生存率在单纯胃切除术组、胃切除术加脾切除术组和胃切除术加远端胰腺切除术组之间无显著差异。纵隔 LN 孤立性复发率为 AEG 的 0.7%，伴该复发的总中位生存期为 30.5 个月。纵隔 LN 复发的 ViR（43.6）高于区域 LN（20.9）或远处 LN（14.6）转移。
在 LN 转移和复发方面，不进行全纵隔 LN 清扫的经胸入路是可以接受的，对于起源于胃的 AEG II 或 AEG III，常规脾切除术不是必需的。
