Research progress of inferior mediastinal lymphadenectomy in surgery for Siewert type Ⅱ and m adenocarcinoma of the esophagogastric junction
10.3760/cma.j.issn.1673-9752.2019.03.018
- VernacularTitle:SiewertⅡ型和Ⅲ型食管胃结合部腺癌手术中下纵隔淋巴结清扫的研究进展
- Author:
Jie WANG
1
;
Qisheng CHENG
;
Yong LIU
;
Xianghuang MEI
;
Wenqing HU
Author Information
1. 长治医学院附属和济医院胃肠外科
- Keywords:
Adenocarcinoma of the esophagogastric junction;
Gastric neoplasms;
Advanced;
Lymphadenectomy;
Inferior mediastinal lymph nodes
- From:
Chinese Journal of Digestive Surgery
2019;18(3):292-296
- CountryChina
- Language:Chinese
-
Abstract:
In recent years,the incidence of gastric cancer has shown a decreasing trend.However,the incidence of adenocarcinoma of the esophagogastric junction (AEG) is gradually increasing.Different from esophageal cancer and gastric cancer,AEG has distinct pathological types,with low early diagnostic rate and poor prognosis.At present,the main therapeutic measure is surgery for advanced Siewert type Ⅱ and Ⅲ AEG.The key to a successful operation is complete resection of tumor and thorough lymphadenectomy,especially the upper abdominal and inferior mediastinal lymph nodes (No.110 the lower thoracic paraesophageal lymph nodes and No.111 the supradiaphragmatic lymph nodes).For the advanced Siewert type Ⅱ and Ⅲ AEG invading lower thoracic esophagus,it is required to perform gastrectomy with D2 lymphadenectomy,which includes upper abdominal and inferior mediastinal lymphadenectomy.There has been reached a consensus on complete resection of tumor and thorough lymphadenectomy.However,there is still controversy in the inferior mediastinal lymphadenectomy,particularly lower thoracic paraesophageal lymph nodes and supradiaphragmatic lymph nodes.Since specific lymphatic drainage of the esophagogastric junction,it is necessary to dissect inferior mediastinal lymph nodes.The metastatic rate of the inferior mediastinal lymph nodes determines the extent of inferior mediastinal lymphadenectomy.D2 lymphadenectomy (including inferior mediastinal lymphadenectomy) could achieve more thorough clearance for perigastric metastatic lymph nodes.Meanwhile,it could increase the survival rate of postoperative patients and improve their prognosis.
