Résumé
Objective:By analyzing the relationship between postoperative pathology and lymph node metastasis of the adenocarcinoma of esophagogastric junction patients to explore the effect of surgical resection and lymph node cleaning scope on prognosis in different Siewert type patients.Methods:A retrospective analysis was made on 350 cases of esophageal gastric junction adenocarcinoma at Tumor Hospital of Shanxi Province from July 2014 to May 2018. Patients clinical data such as lymph node metastasis and tumor diameter, differentiation degree, infiltration depth were studied. The value of the third leg of lymph node cleaning in cardia cancer radical were discussed. Risk factors of lymph node metastasis were analyzed by Logistic regression model.Results:A total of 6 718 lymph nodes were dissected in 350 patients with adenocarcinoma of esophagogastric junction, including 1 613 positive lymph nodes, with a metastasis rate of 24.01%. The metastatic rate of Siewert type Ⅰ lymph nodes was 23.30%, 20.16%, 41.90% and 20.87% in the first, second, third and seventh groups, respectively, which was significantly higher than that of other groups. Siewert Ⅱ and Ⅲ focus on the abdominal cavity. with the increase of tumor infiltration depth, the rate of peripheral lymph node metastasis increased, and the difference was statistically significant ( P<0.01). The rate of lymph node metastasis was 83.1% in the low-differentiation group and 58.4% in the middle-high differentiation group, respectively ( P<0.01). When the tumor diameter ≥4 cm, the rate of lymph node metastasis in the patients increased significantly, and the difference was statistically significant ( P<0.05). The rate of lymph node metastasis at the third station was correlated with the depth of invasion of the gastric wall, the longest diameter of the tumor body, and the degree of differentiation of the tumor. Conclusions:The longest diameter of tumor body, the depth of infiltration and the degree of differentiation are independent risk factors for lymph node metastasis in AEG patients. For patients with type AEG Ⅰ, the mediastinal and lower esophageal lymph nodes should be thoroughly dissected during radical surgery, and the abdominal lymph nodes in groups 1, 2, 3 and 7 should be dissected. The remaining groups may have to be examined for enlarged lymph nodes to determine whether to dissect. For type Ⅱ and Ⅲ patients, splenoprotective total gastrectomy and D 2 lymph node dissection are recommended when the tumor invades the full layer of the gastric wall, the longest diameter ≥4 cm, and the differentiation degree is low.