Benefit Of Abdominal Lymph Node Dissection And Prognosis Of No.16 Lymph Node Metastasis In Patients With Resectable Adenocarcinoma Of The Esophagogastric Junction

Objective:To study the benefit of abdominal lymph node dissection for resectable esophageal gastric junction adenocarcinoma,and to explore the high-risk factors and prognosis of paraaortic lymph nodes(PALNs)。Methods:This is a single center retrospective study.98 patients with resectable adenocarcinoma of the esophagogastric junction in Shanxi Provincial People’s Hospital(between January 2014 and January 2019)were analyzed.All patients underwent D2 +No.16 lymph node dissection and did not receive neoadjuvant chemotherapy.Calculate the benefit of lymph node dissection at each station,count the lymph node metastasis rate of No.16 lymph node in these patients,analyze the relationship between No.16 lymph node metastasis and other regional lymph nodes and clinicopathological features,and observe the 3-year survival status of patients with No.16 lymph node metastasis.Results:Among 98 AEG patients who underwent at least D2+No.16 lymph node dissection,the lymph node sites with metastasis rate ≥ 10.0% included stations No.1(27.6%),No.2(18.4%),No.3(54.1%),No.4(24.5%),No.8a(12.2%),No.9(10.2%),No.10(12.2%),No.11p(15.3%)and No.16a2(18.4%,whereas the lymph node sites with metastasis rate of 5% ～ 10% included stations No.5(9.2%),No.6(8.2%),No.7(8.2%),No.8p(4.1%),No.12a(8.2%),No.16a1(8.2%)and No.16b1(5.1%).Dissection of distal gastric(No.5,No.12)lymph nodes and branch of celiac artery(No.7,No.9)lymph nodes does not seem to be beneficial(IEBLD<10),but dissection of pericardial(No.1,No.2)lymph nodes,lesser curved(No.3)lymph nodes,greater curved(No.4)lymph nodes and splenic artery(No.11)lymph nodes will produce greater therapeutic benefits(IEBLD >10).In Siewert III AEG,dissection of infrapyloric(No.6)lymph nodes,splenic hilum(No.10)lymph nodes and paraaortic(No.16)lymph nodes can obtain greater therapeutic benefits(IEBLD > 10).Univariate analysis showed that No.16 lymph node metastasis was related to No.3,No.4,No.5,No.7,No.8a,No.8p,No.9,No.10,No.11 p,No.11 d,No.12 a,No.12 b lymph node metastasis,P < 0.05.In terms of clinicopathological features,No.16 lymph node metastasis was related to age,preoperative BMI,tumor size,Borrmann classification,Siewert classification,tumor T stage,tumor N stage and pathological stage,P < 0.05,Multivariate analysis by logistic regression model showed that tumor diameter ≥ 4cm was a high-risk factor for No.16 lymph node metastasis(P= 0.01).The post-operative 3-year cumulative survival rate of No.16 lymph node metastasis negative patients was 72.2%,and that of positive patients was 65.4%.Log rank test was used to compare the survival difference between the two groups.The results showed that there was no significant difference in the overall survival rate between No.16 metastasis negative patients and positive patients(P = 0.465).Conclusion:Patients with AEG should be dissected paracardia,lesser curvature of stomach,greater curvature of stomach and splenic artery lymph nodes,which can obtain better survival benefits.In Siewert III AEG,dissection of infrapyloric(No.6)lymph nodes,splenic hilum(No.10)lymph nodes and paraaortic(No.16)lymph nodes can obtain greater therapeutic benefits than Siewert I and II;The rate of No.16 lymph node metastasis is high,and a variety of clinicopathological features are related to No.16 lymph node metastasis.It is recommended to routinely dissect No.16 lymph nodes when the tumor diameter is ≥ 4cm;Although the post-operative 3-year cumulative survival rate of No.16 lymph node metastasis-positive patients was lower than that of negative patients,but there was no significant difference in the survival curve between the two groups statistically,the survival status of NO.16 lymph node metastasis-positive patients reached the level of negative patients by receiving PAND.