Survival Benefit of Pyloric Lymph Node Dissection for Siewert Type II/III Adenocarcinoma of the Esophagogastric Junction Based on Tumor Diameter: A Large Cohort Study

BackgroundIt is unclear whether the dissection of pyloric lymph nodes (PLNs, No. 5 and No. 6 lymph nodes) is necessary for adenocarcinoma of the esophagogastric junction (AEG) with a tumor diameter >4 cm based on current guidelines. This study aimed at evaluating whether pyloric node lymphade...

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Autores principales:	Xia Lin, Zhengyan Li, Chenjun Tan, Xiaoshuang Ye, Jie Xiong, Jiajia Liu, Ao Mo, Yan Shi, Feng Qian, Peiwu Yu, Yongliang Zhao
Formato:	article
Lenguaje:	EN
Publicado:	Frontiers Media S.A. 2021
Materias:	gastric cancer AEG Siewert classification lymphadenectomy prognosis Neoplasms. Tumors. Oncology. Including cancer and carcinogens RC254-282
Acceso en línea:	https://doaj.org/article/fab627e97e4c406ca2fa6f16616d20ab
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spelling	oai:doaj.org-article:fab627e97e4c406ca2fa6f16616d20ab2021-12-01T21:24:00ZSurvival Benefit of Pyloric Lymph Node Dissection for Siewert Type II/III Adenocarcinoma of the Esophagogastric Junction Based on Tumor Diameter: A Large Cohort Study2234-943X10.3389/fonc.2021.748694https://doaj.org/article/fab627e97e4c406ca2fa6f16616d20ab2021-12-01T00:00:00Zhttps://www.frontiersin.org/articles/10.3389/fonc.2021.748694/fullhttps://doaj.org/toc/2234-943XBackgroundIt is unclear whether the dissection of pyloric lymph nodes (PLNs, No. 5 and No. 6 lymph nodes) is necessary for adenocarcinoma of the esophagogastric junction (AEG) with a tumor diameter >4 cm based on current guidelines. This study aimed at evaluating whether pyloric node lymphadenectomy is essential for patients with Siewert type II/III AEG according to different tumor diameters.MethodsThis study included 300 patients on whom transabdominal total gastrectomy was performed for Siewert type II/III AEG at a high-volume center in China from January 2006 to December 2015. The index of estimated benefit from lymph node dissection (IEBLD) was used to analyze the priority of pyloric lymphadenectomy.ResultsIn Siewert type II AEG, the 5-year overall survival (OS) and the 5-year disease-free survival (DFS) were similar between patients with PLN-positive cancer and patients of stage III AEG without PLN metastasis (23.1% vs. 30.6%, p = 0.505; 23.1% vs. 27.1%, p = 0.678). However, in Siewert type III AEG, the OS and the DFS of patients with PLN-positive cancer were significantly lower than that of patients with stage III without PLN metastasis (7.9% vs. 27.8%, p = 0.021; 0 vs. 26.8%, p = 0.005). According to the IEBLD, the dissection of PLNs did not appear to be beneficial in either Siewert type II AEG or type III AEG, whereas a stratified analysis revealed that PLN dissection yielded a high therapeutic benefit for Siewert type II AEG with tumor diameters >4 cm.ConclusionWe recommended that the PLNs be dissected in Siewert type II AEG when a tumor diameter is >4 cm. Total gastrectomy should be optional for Siewert type II AEG with a tumor diameter >4 cm and Siewert type III AEG.Xia LinXia LinZhengyan LiChenjun TanXiaoshuang YeJie XiongJiajia LiuAo MoYan ShiFeng QianPeiwu YuYongliang ZhaoFrontiers Media S.A.articlegastric cancerAEGSiewert classificationlymphadenectomyprognosisNeoplasms. Tumors. Oncology. Including cancer and carcinogensRC254-282ENFrontiers in Oncology, Vol 11 (2021)
institution	DOAJ
collection	DOAJ
language	EN
topic	gastric cancer AEG Siewert classification lymphadenectomy prognosis Neoplasms. Tumors. Oncology. Including cancer and carcinogens RC254-282
spellingShingle	gastric cancer AEG Siewert classification lymphadenectomy prognosis Neoplasms. Tumors. Oncology. Including cancer and carcinogens RC254-282 Xia Lin Xia Lin Zhengyan Li Chenjun Tan Xiaoshuang Ye Jie Xiong Jiajia Liu Ao Mo Yan Shi Feng Qian Peiwu Yu Yongliang Zhao Survival Benefit of Pyloric Lymph Node Dissection for Siewert Type II/III Adenocarcinoma of the Esophagogastric Junction Based on Tumor Diameter: A Large Cohort Study
description	BackgroundIt is unclear whether the dissection of pyloric lymph nodes (PLNs, No. 5 and No. 6 lymph nodes) is necessary for adenocarcinoma of the esophagogastric junction (AEG) with a tumor diameter >4 cm based on current guidelines. This study aimed at evaluating whether pyloric node lymphadenectomy is essential for patients with Siewert type II/III AEG according to different tumor diameters.MethodsThis study included 300 patients on whom transabdominal total gastrectomy was performed for Siewert type II/III AEG at a high-volume center in China from January 2006 to December 2015. The index of estimated benefit from lymph node dissection (IEBLD) was used to analyze the priority of pyloric lymphadenectomy.ResultsIn Siewert type II AEG, the 5-year overall survival (OS) and the 5-year disease-free survival (DFS) were similar between patients with PLN-positive cancer and patients of stage III AEG without PLN metastasis (23.1% vs. 30.6%, p = 0.505; 23.1% vs. 27.1%, p = 0.678). However, in Siewert type III AEG, the OS and the DFS of patients with PLN-positive cancer were significantly lower than that of patients with stage III without PLN metastasis (7.9% vs. 27.8%, p = 0.021; 0 vs. 26.8%, p = 0.005). According to the IEBLD, the dissection of PLNs did not appear to be beneficial in either Siewert type II AEG or type III AEG, whereas a stratified analysis revealed that PLN dissection yielded a high therapeutic benefit for Siewert type II AEG with tumor diameters >4 cm.ConclusionWe recommended that the PLNs be dissected in Siewert type II AEG when a tumor diameter is >4 cm. Total gastrectomy should be optional for Siewert type II AEG with a tumor diameter >4 cm and Siewert type III AEG.
format	article
author	Xia Lin Xia Lin Zhengyan Li Chenjun Tan Xiaoshuang Ye Jie Xiong Jiajia Liu Ao Mo Yan Shi Feng Qian Peiwu Yu Yongliang Zhao
author_facet	Xia Lin Xia Lin Zhengyan Li Chenjun Tan Xiaoshuang Ye Jie Xiong Jiajia Liu Ao Mo Yan Shi Feng Qian Peiwu Yu Yongliang Zhao
author_sort	Xia Lin
title	Survival Benefit of Pyloric Lymph Node Dissection for Siewert Type II/III Adenocarcinoma of the Esophagogastric Junction Based on Tumor Diameter: A Large Cohort Study
title_short	Survival Benefit of Pyloric Lymph Node Dissection for Siewert Type II/III Adenocarcinoma of the Esophagogastric Junction Based on Tumor Diameter: A Large Cohort Study
title_full	Survival Benefit of Pyloric Lymph Node Dissection for Siewert Type II/III Adenocarcinoma of the Esophagogastric Junction Based on Tumor Diameter: A Large Cohort Study
title_fullStr	Survival Benefit of Pyloric Lymph Node Dissection for Siewert Type II/III Adenocarcinoma of the Esophagogastric Junction Based on Tumor Diameter: A Large Cohort Study
title_full_unstemmed	Survival Benefit of Pyloric Lymph Node Dissection for Siewert Type II/III Adenocarcinoma of the Esophagogastric Junction Based on Tumor Diameter: A Large Cohort Study
title_sort	survival benefit of pyloric lymph node dissection for siewert type ii/iii adenocarcinoma of the esophagogastric junction based on tumor diameter: a large cohort study
publisher	Frontiers Media S.A.
publishDate	2021
url	https://doaj.org/article/fab627e97e4c406ca2fa6f16616d20ab
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Survival Benefit of Pyloric Lymph Node Dissection for Siewert Type II/III Adenocarcinoma of the Esophagogastric Junction Based on Tumor Diameter: A Large Cohort Study

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