演題抄録

International Workshop

開催概要
開催回
第54回・2016年・横浜
 

High risk group of mediastinal lymph node metastasis in patents with esophagogastric junction carcinoma

演題番号 : IWS3-5

[筆頭演者]
由良 昌大:1 
[共同演者]
竹内 裕也:1、須田 康一:1、中村 理恵子:1、和田 則仁:1、川久保 博文:1、北川 雄光:1

1:慶應義塾大学・医学部・一般・消化器外科

 

Purpose: The aim of this study was to clarify the high risk group of mediastinal lymph node (MLN) metastasis in patents with EGJ carcinoma.
Methods: This retrospective study included 114 consecutive patients with EGJ carcinoma who underwent R0/R1 resection at Keio University Hospital between January 2000 and July 2014. EGJ carcinoma was characterized using Nishi's classification (adenocarcinoma: AC, N = 88; squamous cell carcinoma: SCC, N = 26).
Results: Of the 114 patients, 19 (16%) had MLN metastasis. There were significant differences between MLN positive group and negative group about length from EGJ to tumor epicenter, tumor esophageal invasion and pT factor. Patients in whom the tumor epicenter was located above the EGJ had a significantly higher incidence of MLN metastasis (18/51; 35%) than those whose epicenter was located below the EGJ (1/63; 1.6%).The rate of metastasis was found to be particularly high when the distance from the EGJ to the proximal edge of the primary tumor was ≧ 3 cm for upper or middle MLN (16.6% and 8.3%, respectively) and ≧ 2 cm for lower MLN (29.4%). Of the total number of patients, 13 (N=9; AC, N=4; SCC) were found to have upper-middle MLN metastasis or recurrence, and all had ≧ pT2 tumor .In these patients, 3 had tumor epicenter located in gastric side and 10 was esophageal side. We draw up algorithm for EGJ carcinoma according to the location of tumor epicenter, T factor and length of esophageal invasion. In this algorithm, high risk group patients (≧T2 and tumor epicenter located esophageal side or gastric side with ≧3cm esophageal invasion) showed that rate of upper and middle MLN metastasis or recurrence was 20% and 15% respectively.
Conclusions: The location of the tumor epicenter, pT factor, and degree of esophageal invasion were all related to MLN metastasis. In our algorithm, high risk group patients should be perfomed upper and middle MLN dissection.

キーワード

臓器別:食道

手法別:手術療法

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