title: Should Splenic Hilar Lymph Nodes be Dissected for Siewert Type II and III Esophagogastric Junction Carcinoma Based on Tumor Diameter?: A Retrospective Database Analysis.
abstract: The aim of the study is to identify the value of a spleen-preserving No. 10 lymphadenectomy (SPL) for Siewert type II/III adenocarcinoma of the esophagogastric junction (AEG).From January 2007 to June 2014, 694 patients undergoing radical total gastrectomy for Siewert type II/III AEG were analyzed. Oncologic outcomes were compared between SPL and no SPL (No. 10D+ and No. 10D-) groups.The incidence of No. 10 lymph node metastasis (LNM) was 12.3%. No significant differences in the incidence of No. 10 LNM were found between Siewert type II AEG with tumor diameters of <4 cm and ≥4 cm (P = 0.071). However, Siewert type III AEG with a tumor diameter ≥4 cm showed a significantly higher frequency of No. 10 LNM compared with a tumor diameter <4 cm (P < 0.001). The No. 10D+ group had superior 3-year overall survival (OS) and disease-free survival (DFS) rates compared with the No. 10D- group (P = 0.030 and P = 0.005, respectively). For patients with Siewert type II and type III AEG with a tumor diameter <4 cm, the 3-year OS and DFS rates were similar between the 2 groups. However, the No. 10D+ group had better 3-year OS (66.6% vs 51.1%, P = 0.019) and DFS (63.2% vs 45.9%, P = 0.007) rates for Siewert type III AEG with a tumor diameter ≥4 cm. A multivariate Cox regression showed that SPL was an independent prognostic factor in Siewert type III AEG with a tumor diameter ≥4 cm.SPL may improve the prognosis of Siewert type III AEG with a tumor diameter ≥4 cm, whereas SPL may be omitted without decreasing survival in patients with Siewert type II or type III AEG with a tumor diameter <4 cm.
authors.affiliation: From the Department of Gastric Surgery, Fujian Medical University Union Hospital, Fuzhou, Fujian Province, China.
authors.forename: Chen-Bin
authors.initials: CB
authors.lastname: Lv
authors.forename: Chang-Ming
authors.initials: CM
authors.lastname: Huang
authors.forename: Chao-Hui
authors.initials: CH
authors.lastname: Zheng
authors.forename: Ping
authors.initials: P
authors.lastname: Li
authors.forename: Jian-Wei
authors.initials: JW
authors.lastname: Xie
authors.forename: Jia-Bin
authors.initials: JB
authors.lastname: Wang
authors.forename: Jian-Xian
authors.initials: JX
authors.lastname: Lin
authors.forename: Jun
authors.initials: J
authors.lastname: Lu
authors.forename: Qi-Yue
authors.initials: QY
authors.lastname: Chen
authors.forename: Long-Long
authors.initials: LL
authors.lastname: Cao
authors.forename: Mi
authors.initials: M
authors.lastname: Lin
authors.forename: Ru-Hong
authors.initials: RH
authors.lastname: Tu
mesh_terms: D000230:Adenocarcinoma / Q000473:pathology*; D000368:Aged; D015897:Comorbidity; D018572:Disease-Free Survival; D004943:Esophagogastric Junction / Q000473:pathology*; D005260:Female; D005743:Gastrectomy; D006801:Humans; D008197:Lymph Node Excision / Q000379:methods*; D008207:Lymphatic Metastasis; D008297:Male; D008875:Middle Aged; D016016:Proportional Hazards Models; D012189:Retrospective Studies; D013274:Stomach Neoplasms / Q000473:pathology* / Q000601:surgery; D047368:Tumor Burden