The pattern of metastatic lymph node dissemination from adenocarcinoma of the esophagogastric junction

Background. The incidence of adenocarcinoma of the esophagogastric junction is rapidly increasing and the extent of lymphadenectomy for such tumors re mains controversial. The aim of this study was to identify the pattern Of d issemination by examination of all lymph nodes retrieved from resected tumo rs of the esophagogastric junction. Methods, The endoscopic and pathologic reports of patients who underwent RO resection for adenocarcinoma of the esophagogastric junction between Janua ry 1996 and November 1999 were examined. Patients with type I tumors (dista l esophagus) underwent subtotal esophagectomy with 2-field lymphadenectomy. Patients with type 2 (gastric cardia) tumors underwent transhiatal D2 tota l gastro-esophagectomy. Lymph node groups were dissected from the main spec imens and examined separately. Results. One hundred and four type I and 48 type 2 tumors were studied. Med ian nodal recovery wets 23 lymph nodes (type 1, 22 lymph nodes; type 2 23 l ymph nodes). Seventy-eight percent of the type 1 tumors with nodal metastas es had dissemination in both the abdomen and mediastinum. The common abdomi nal sites were the paracardiac and the left gastric stations. Within the me diastinum, paraesophageal, paraaortic and tracheobronchial metastases were more often encountered. Type 2 tu,nors had positive lymph nodes most freque ntly in the left and right paracardiac, lesser curve (NI group), and left g astric (N2 group) territories. Nodal status correlated with increasing dept h of tumor invasion (P = .002). Conclusions. The pattern of nodal dissemination for cardia tumors concurs w ith that described by other studies. The current definition of nodal fields in the abdomen and mediastinum for esophageal tumors relates to experience with squamous carcinomas. Our results demonstrate a different pattern of d issemination for junctional esophageal adenocarcinomas. The nodal stations to be resected in radical lymphadenectomies for such tumors should be redef ined.