Therapeutic value of lymph node dissection for Siewert type II and III adenocarcinoma: meta-analysis.

BACKGROUND: Adenocarcinoma of the oesophagogastric junction presents an increasing incidence. Surgical resection with lymphadenectomy is the only curative treatment modality at the present time, but the optimal extent of lymphadenectomy is debatable. The aim of the present meta-analysis was to estimate the therapeutic value of each nodal station. METHODS: Studies reporting the therapeutic value index of each nodal station in Siewert types II/III oesophagogastric junction (EGJ) were searched in PubMed, Web of Science and Embase up to October 2022. This index was calculated by multiplication of metastatic incidence and 5-year overall survival rate at each nodal station. Risk of bias was assessed using the Joanna Briggs Institute Critical Appraisal Checklist for Prevalence Studies. Pooled metastatic incidence and therapeutic value index were calculated using RevMan 5.4. RESULTS: Twelve studies involving 3513 patients were included. Nodes No. 3, 1, 7 and 2 were routinely dissected and achieved a high (≥10) or moderate (5-10) therapeutic value index in decreasing order, due to their high metastatic incidence and favourable survival rate. The index was relatively low (2-5) in suprapancreatic nodes No. 9, 11p and 8a. The index for nodes No. 4d and 10 was relatively low in Siewert type Ⅲ EGJ but very low (<2) in type Ⅱ. The index was very low for nodes No. 5, 6, 11d and 12a, due to their low metastatic incidence and poor survival if positive. Para-aortic, parahiatal and mediastinal nodes were dissected only in highly selected cases. Dissection of the lower mediastinal nodes, especially No. 110, could improve survival rates in type Ⅱ EGJ. CONCLUSION: These data could help assess the optimal extent of lymphadenectomy for EGJ. Nodes No. 1, 2, 3, 7, 8a, 9 and 11p need routine dissection in both Siewert types Ⅱ/Ⅲ EGJ; nodes around the lower oesophagus (especially No. 110) in Siewert type Ⅱ EGJ and nodes No. 4d and 10 in Siewert type Ⅲ EGJ might be considered for dissection.

Incidence of lymph node metastasis at each station in Siewert types â ¡/â ¢ adenocarcinoma of the esophagogastric junction: A systematic review and meta-analysis.

The optimal extent of lymphadenectomy for adenocarcinoma of the esophagogastric junction (AEG) has been continuously debatable. The study aimed to determine the incidence of lymph node metastasis at each station in Siewert types Ⅱ/Ⅲ AEG. PubMed was searched and publications reporting metastasis at each nodal station were eligible. Meta-analysis was performed using RevMan 5.3. Twenty-one studies involving 4662 patients were included. The incidence of lymph node metastasis was high (≥20%) in stations No. 3, 1, 2 and 7 in decreasing order, and moderate (10-20%) in stations No. 9, 19 and 110. The incidence did not exceed 10% in stations No. 10, 11p, 20, 8a, 4sa, 4 s b and 4d, was less than 5% in stations No. 5, 6, 11d, 12a, and even close to 0 in stations No. 107, 111 and 112. Compared with type Ⅲ tumors, type Ⅱ tumors had significantly lower incidence in some abdominal stations including No. 3, 4sa, 4 s b, 6, 8a and 10, while significantly higher in the lower mediastinal stations. The present analysis established a map of lymph node metastasis in Siewert types Ⅱ/Ⅲ AEG, which may serve as a valuable reference for the extent of lymphadenectomy.