title: Lymph node metastasis from cancer of the esophagogastric junction, and determination of the appropriate nodal dissection.
abstract: OBJECTIVE
  Both squamous cell carcinomas and adenocarcinomas can develop in the esophagogastric junction. To clarify the appropriate lymph node dissection range, lymph node metastases from cancers in the esophagogastric junction were investigated.
  
  
  METHODS
  The nodal metastases were analyzed in 64 patients with squamous cell carcinoma and 129 with adenocarcinoma according to Siewert's classification, which is based on topographic anatomical criteria for adenocarcinoma.
  
  
  RESULTS
  The squamous cell carcinomas located above the esophagocardial junction had more frequent metastasis to the lower and middle mediastinal lymph nodes in proportion to the depth of the tumor. Nodal metastasis was also often detected in the abdominal lymph nodes. In contrast, adenocarcinomas metastasized less frequently to the mediastinal lymph nodes, and the metastatic rates in the abdominal nodes were higher than those from squamous cell carcinoma.
  
  
  CONCLUSIONS
  Esophagectomy with mediastinal and abdominal lymph node dissection is considered to be an appropriate approach for surgical resection of squamous cell carcinomas, whereas transhiatally extended gastrectomy with lower mediastinal and abdominal lymph node dissection is recommended for the treatment of adenocarcinomas.
authors.affiliation: Department of Surgery and Science, Graduate School of Medical Sciences, Kyushu University, Maidashi 3-1-1, Higashi-ku, Fukuoka, 812-8582, Japan. kakeji@surg2.med.kyushu-u.ac.jp
authors.forename: Yoshihiro
authors.initials: Y
authors.lastname: Kakeji
authors.forename: Manabu
authors.initials: M
authors.lastname: Yamamoto
authors.forename: Shuhei
authors.initials: S
authors.lastname: Ito
authors.forename: Masahiko
authors.initials: M
authors.lastname: Sugiyama
authors.forename: Akinori
authors.initials: A
authors.lastname: Egashira
authors.forename: Hiroshi
authors.initials: H
authors.lastname: Saeki
authors.forename: Masaru
authors.initials: M
authors.lastname: Morita
authors.forename: Yoshihisa
authors.initials: Y
authors.lastname: Sakaguchi
authors.forename: Yasushi
authors.initials: Y
authors.lastname: Toh
authors.forename: Yoshihiko
authors.initials: Y
authors.lastname: Maehara
mesh_terms: D000230:Adenocarcinoma / Q000473:pathology / Q000601:surgery; D002294:Carcinoma, Squamous Cell / Q000473:pathology / Q000601:surgery; D004938:Esophageal Neoplasms / Q000473:pathology* / Q000601:surgery; D016629:Esophagectomy / Q000379:methods*; D004943:Esophagogastric Junction / Q000473:pathology / Q000601:surgery*; D006801:Humans; D008197:Lymph Node Excision / Q000379:methods; D008198:Lymph Nodes / Q000473:pathology* / Q000601:surgery; D008207:Lymphatic Metastasis / Q000473:pathology; D009362:Neoplasm Metastasis / Q000473:pathology; D009364:Neoplasm Recurrence, Local