Prevalence and Spread of Lymph Node Metastases in Early Adenocarcinoma of the Esophago-Gastric Junction
Abstracts
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Background: In the treatment of early adenocarcinoma of the esophago-gastric junction limited surgical approaches are of high interest. The absence of lymph node metastases is required to limit the extend of resection. We investigated the prevalence and spread of lymph node metastases in patients with high-grade dysplasia and early carcinoma (pT1-category) of the esophago-gastric junction. Methods: We analyzed the localization and amount of lymph node involvement in 160 patients with high-grade dysplasia or pT1 adenocarcinoma of the distal esophagus (n=99, AEG type I), the gastric cardia (n=40, AEG type II) or subcardial localisation (n=21, AEG type III). In all patients a radical en-bloc resection with extended lymphadenectomy of the upper abdominal compartment and lower mediastinum was performed. Results: A total amount of 3656 lymph nodes were investigated (median 21 lymph nodes per patient, rank 15-74). No lymph nodes were present in 43 patients with a high-grade dysplasia or to the mucosa limited carcinoma (pT1a-category). In contrast were in 14 of 117 (11.9%) of the patients with an infiltration of the submucosa (pT1b-category) lymph node metastases recognizable (median 2, rank 1-14). The lymph node metastases were mainly located paracardial, paraesophageal and on the lesser gastric curvature. No significant difference in the prevalence, amount and location of the lymph node metastases between the AEG types I to III was found. Conclusion: Exclusively on high-grade dysplasia or to the mucosa limited adenocarcinoma (pT1a-category) of the esophago-gastric junction a lymphadenectomy is not mandatory. In more than 10% of the pT1b carcinomas already loco-regional lymph node metastases are present. |
