title: Impact of lower mediastinal lymphadenectomy for the treatment of esophagogastric junction carcinoma.
abstract: OBJECTIVE
  To define the optimal extent of resection for esophagogastric junction (EGJ) carcinoma.
  
  
  METHODS
  We retrospectively reviewed medical records of 193 patients with EGJ adenocarcinoma or squamous cell carcinoma who underwent surgery at the Kitasato University. An index was calculated to evaluate the therapeutic value of lymphadenectomy.
  
  
  RESULTS
  The following factors were identified as independent predictors of poor survival: (y)pT3-4, (y)pN3, ly2-3, no performance of splenectomy and R1-2. Although metastases were found in mediastinal lymph-nodes in patients with esophageal invasion of ≤30 mm, the index was 0 for all mediastinal lymph-nodes. By contrast, in patients with esophageal invasion of >30 mm, the index was 13.9 for the No. 110 nodes, which was the second highest after the index for the No. 1 nodes.
  
  
  CONCLUSIONS
  In EGJ cancer patients with esophageal invasion of >30 mm, aggressive lower mediastinal lymphadenectomy with R0 resection is required to obtain the best result.
authors.affiliation: Department of Surgery, Kitasato University School of Medicine, Kanagawa, Japan k.hosoda@kitasato-u.ac.jp.
authors.forename: Kei
authors.initials: K
authors.lastname: Hosoda
authors.affiliation: Department of Surgery, Kitasato University School of Medicine, Kanagawa, Japan.
authors.forename: Keishi
authors.initials: K
authors.lastname: Yamashita
authors.affiliation: Department of Surgery, Kitasato University School of Medicine, Kanagawa, Japan.
authors.forename: Natsuya
authors.initials: N
authors.lastname: Katada
authors.affiliation: Department of Surgery, Kitasato University School of Medicine, Kanagawa, Japan.
authors.forename: Hiromitsu
authors.initials: H
authors.lastname: Moriya
authors.affiliation: Department of Surgery, Kitasato University School of Medicine, Kanagawa, Japan.
authors.forename: Hiroaki
authors.initials: H
authors.lastname: Mieno
authors.affiliation: Department of Surgery, Kitasato University School of Medicine, Kanagawa, Japan.
authors.forename: Shinichi
authors.initials: S
authors.lastname: Sakuramoto
authors.affiliation: Department of Surgery, Kitasato University School of Medicine, Kanagawa, Japan.
authors.forename: Shiro
authors.initials: S
authors.lastname: Kikuchi
authors.affiliation: Department of Surgery, Kitasato University School of Medicine, Kanagawa, Japan.
authors.forename: Masahiko
authors.initials: M
authors.lastname: Watanabe
mesh_terms: D000230:Adenocarcinoma / Q000401:mortality / Q000556:secondary / Q000601:surgery*; D000328:Adult; D000368:Aged; D000369:Aged, 80 and over; D004938:Esophageal Neoplasms / Q000401:mortality / Q000473:pathology / Q000601:surgery*; D004943:Esophagogastric Junction / Q000473:pathology; D005260:Female; D006801:Humans; D053208:Kaplan-Meier Estimate; D008197:Lymph Node Excision; D008198:Lymph Nodes / Q000473:pathology / Q000601:surgery*; D008207:Lymphatic Metastasis; D008297:Male; D008482:Mediastinum; D008875:Middle Aged; D009364:Neoplasm Recurrence, Local / Q000517:prevention & control*; D011379:Prognosis; D012189:Retrospective Studies; D013274:Stomach Neoplasms / Q000401:mortality / Q000473:pathology / Q000601:surgery*; D016896:Treatment Outcome; D055815:Young Adult
keywords: Esophagogastric junction; lymph node excision; neoplasms; prognosis; surgery