title: Topographical distribution of lymph node metastasis in adenocarcinoma of the gastroesophageal junction.
abstract: OBJECTIVE
  The current discussion concerning the extent of resection in patients with adenocarcinoma of the gastroesophageal junction is focused beside the luminal extent of resection primarily on the value of lymphadenectomy.
  
  
  METHODS
  In order to clarify whether spread of lymph node metastasis shows different pathways in adenocarcinomas of the gastroesophageal junction, a prospective, morphological study of the topographical distribution of lymph node metastasis was performed. Transthoracic en bloc esophagectomy with two-field lymphadenectomy (n = 13) or transhiatal esophagectomy with lymphadenectomy of the lower mediastinum and compartment I (lymph node No. 1-3) as well as II (n = 4) was performed in type I carcinoma and transhiatally extended gastrectomy with D2-lymphadenectomy and lymphadenectomy of the lower mediastinum in type II and III carcinoma (n = 33).
  
  
  RESULTS
  In 50 specimens, 1730 lymph nodes were evaluated with regard to metastatic infiltration. We found metastases in the lymph nodes of the lower mediastinum in 24% of type I carcinoma, in 11% of type II carcinoma and in 13% of type III carcinoma, whereas the lymph nodes of the upper mediastinum were tumor free in all patients with transthoracic en bloc resection and 2-field lymphadenectomy (n = 13). In all cases with lymph node metastasis abdominal lymph nodes were affected independently from the localization of the primary tumor.
  
  
  CONCLUSIONS
  The main direction of lymph node spread in adenocarcinoma of the gastroesophageal junction is towards the abdomen and the lower mediastinum. For precise tumor staging standardized lymphadenectomy of the lower mediastinum and the abdominal compartments I and II is essential.
authors: Department of Visceral and Vascular Surgery, University of Cologne, Joseph-Stelzmann-Str. 9, 50924 Cologne, Germany. MoenigSt@aol.com
authors: Stefan P
authors: SP
authors: Mönig
authors: Stephan E
authors: SE
authors: Baldus
authors: Thomas K
authors: TK
authors: Zirbes
authors: Peter H
authors: PH
authors: Collet
authors: Wolfgang
authors: W
authors: Schröder
authors: Paul M
authors: PM
authors: Schneider
authors: Hans P
authors: HP
authors: Dienes
authors: Arnulf H
authors: AH
authors: Hölscher
mesh_terms: D000230:Adenocarcinoma / Q000473:pathology*; D000328:Adult; D000368:Aged; D000369:Aged, 80 and over; D004938:Esophageal Neoplasms / Q000473:pathology* / Q000601:surgery; D016629:Esophagectomy; D004943:Esophagogastric Junction; D005260:Female; D005743:Gastrectomy; D006801:Humans; D008197:Lymph Node Excision; D008207:Lymphatic Metastasis; D008297:Male; D008875:Middle Aged; D011446:Prospective Studies; D013274:Stomach Neoplasms / Q000473:pathology* / Q000601:surgery