Determining anatomical localisations of cervical oesophagus, hiatal clamp and oesophagogastric junction with oesophagogastroduodenoscopy.

BACKGROUND: In this study, the purpose was to determine the anatomical localisations of the cervical oesophagus length, hiatal clamp, and oesophagogastric junction depending on age and gender in patients who undergo oesophagogastroduodenoscopy (EGD). MATERIALS AND METHODS: The images of the patients who underwent EGD between 2018 and 2020 were analysed retrospectively in this study. The distance of the anatomical localisations of the cervical oesophagus length, hiatal clamp, and oesophagogastric junction to the anterior incisors, and the relations of this distance with the demographic characteristics and clinical manifestations of the patients were investigated on the EGD data. RESULTS: A total of 298 patients (174 women, 124 men) were included in the study. The cervical oesophagus length and the distance of the oesophagogastric junction and hiatal clamp localisation of the patients were found to be 15.06 ± 0.57 cm, 37.51 ± 2.23 cm and 38.62 ± 2.23 cm, respectively. It was also found that the mean values of all lengths in males were higher at a statistically significant level than in females (p < 0.001; p < 0.01). CONCLUSIONS: Knowing these anatomical localisations may be important in predicting complications that may occur in this region in EGD and planning the precautions to be taken. We also believe that it will guide clinicians in determining hiatal hernia and related deficiencies.

Prognostic significance of the metastatic lymph node ratio compared to the TNM classification in stage III gastric cancer.

BACKGROUND: We aimed to evaluate a comparative analysis of the prognostic value of the metastatic lymph node ratio (LNR) and pN (TNM) in stage III gastric cancer. PATIENTS AND METHODS: A total of 159 stage III gastric cancer patients with curative gastrectomy were retrospectively analyzed. Cutoff values for LNR were designated according to 25%, 50% and 75% percentiles, 0.07, 0.20 and 0.44 respectively. The LNR was divided into four groups as 0 > LNR1 ≤ 0.07; 0.07 > LNR2 ≤0.20; 0.20 > LNR3 ≤0.44; 0.44 > LNR4 ≤1. RESULTS: The mean age of the patients was 61.1 ± 11.3 years. Male predominance was apparent (73.6%). The 1-year overall survival and recurrence rates were 73.6% and 33.6%, respectively. The univariate cox regression analysis demonstrated age and LNR were the main variables that affected overall survival (OS) (p < 0.05). Harvested lymph nodes less than 16 did not affect OS (p = 0.255). The results of the multivariate cox regression analysis revealed that only LNR was an independent prognostic factor (P < 0.001), while pN was not (p > 0.05). Similar results, as with overall survival, could not be revealed clearly for disease free survival (DFS). CONCLUSIONS: LNR was an independent significant prognostic factor and superior to pN staging in predicting OS but not for DFS in stage III gastric cancer patients. The high LNR levels in our research were found to be associated with poor survival rates. The percentile system we used to determine cutoff values may be considered as a reliable method. Similarly, LNR also provides a reliable prognostic parameter in future staging systems to help guide treatment algorithm plans.