title: Distribution of lymph node metastasis and clinical validity of gastric tube reconstruction in lower thoracic esophageal squamous cell carcinoma with gastric invasion.
abstract: BACKGROUND
  The distribution of lymph node (LN) metastases of esophageal squamous cell carcinoma (SCC) with gastric invasion remains unclear. The purpose of this study was to clarify the relationship between gastric invasion and abdominal LN metastasis in patients with esophageal SCC. Furthermore, the clinical validity of gastric tube reconstruction for those with gastric invasion was investigated.
  
  
  METHODS
  Patients who underwent subtotal esophagectomy at our institution were reviewed. Gastric invasion was evaluated with pretreatment upper gastrointestinal endoscopy and classified into 3 groups: no invasion, Gr 0; slight invasion (0-19 mm), Gr 1; and massive invasion (20 mm or longer), Gr 2. The correlations between gastric invasion, the number of abdominal LN metastases, and postoperative recurrence were investigated.
  
  
  RESULTS
  Of 79 patients, the distribution of pretreatment gastric invasion was Gr 0, 1, and 2 in 57, 15, and 7 patients, respectively. All patients underwent subtotal esophagectomy with gastric tube reconstruction. There was no significant difference in the number of abdominal LN metastases among groups. In survival analysis, the location of the distal end of the tumor was not a predictive factor for postoperative recurrence. Regarding patterns of recurrence, in patients with gastric invasion, there was no remarkable increase in the frequency of recurrence in the abdominal LNs or the regional LNs around the gastric tube.
  
  
  CONCLUSIONS
  Pretreatment gastric invasion did not significantly influence abdominal LN metastasis and postoperative recurrence. In patients with esophageal SCC at the lower thoracic esophagus with gastric invasion, subtotal esophagectomy with gastric tube reconstruction might be a valid surgical procedure.
authors.affiliation: Division of Esophageal Surgery, Shizuoka Cancer Center Hospital, Shizuoka, Japan.
authors.forename: Satoru
authors.initials: S
authors.lastname: Matsuda
authors.forename: Yasuhiro
authors.initials: Y
authors.lastname: Tsubosa
authors.forename: Masahiro
authors.initials: M
authors.lastname: Niihara
authors.forename: Hiroshi
authors.initials: H
authors.lastname: Sato
authors.forename: Katsushi
authors.initials: K
authors.lastname: Takebayashi
authors.forename: Keisuke
authors.initials: K
authors.lastname: Kawamorita
authors.forename: Keita
authors.initials: K
authors.lastname: Mori
authors.forename: Takahiro
authors.initials: T
authors.lastname: Tsushima
authors.forename: Hirofumi
authors.initials: H
authors.lastname: Yasui
authors.forename: Hiroya
authors.initials: H
authors.lastname: Takeuchi
authors.forename: Yuko
authors.initials: Y
authors.lastname: Kitagawa
mesh_terms: D000368:Aged; D002294:Carcinoma, Squamous Cell / Q000401:mortality / Q000473:pathology / Q000601:surgery*; D004938:Esophageal Neoplasms / Q000401:mortality / Q000473:pathology / Q000601:surgery*; D000077277:Esophageal Squamous Cell Carcinoma; D016629:Esophagectomy; D004947:Esophagus / Q000473:pathology / Q000601:surgery*; D005260:Female; D006801:Humans; D008198:Lymph Nodes / Q000473:pathology*; D008207:Lymphatic Metastasis; D008297:Male; D008875:Middle Aged; D009361:Neoplasm Invasiveness; D013270:Stomach / Q000473:pathology / Q000601:surgery*; D016019:Survival Analysis