Study On The Regularity And Influencing Factors Of Lymph Node Metastasis Of Siewert Ⅱ Adenocarcinoma Of Esophagogastric Junction Around Thorax And Enterocoelia

Objective To investigate the regularity of thoracoabdominal lymph node metastasis in Siewert type Ⅱ esophagogastric junction adenocarcinoma(AEG)patients.The risk factors for mediastinal(110,111,112 group lymph nodes),lower stomach(4,5,6,group lymph nodes)and global lymph node(110,111,112,1,2,3,4,5,6,7,8A,9,10,11,12 A group lymph nodes)metastasis were analyzed.Methods The clinical data of 64 Siewert type Ⅱ esophagogastric junction adenocarcinoma(AEG)patients,including 55 males and 9 females,with an average age of 66.5 years,were retrospectively collected in the Tumor Surgery Department of Chifeng Hospital from January 2019 to December 2021.The surgical methods were right thoracoabdominal incision + radical total gastrectomy and lower esophagus resection + inferior mediastinal lymph node dissection + esophageal jejunum intrathoracic anastomosis.Observation statistics and analysis :(1)overall lymph node and lymph node metastasis rate.(2)Influencing factors of inferior mediastinal lymph node metastasis.(3)Influencing factors of lymph node metastasis in lower stomach.(4)Influencing factors of global lymph node metastasis.Results(1)The overall rate of lymph node metastasis in 64 patients was 45.3%(29/64).The rates of lymph node metastasis were 15.6%(10/64)in 110 groups,6.3%(4/64)in111 groups,3.1%(2/64)in 112 groups,43.8%(28/64)in 1 group,31.3%(20/64)in 2groups,35.9%(23/64)in 3 groups,10.9%(7/64)in 4 groups and 4 in 5 groups,respectively 6 groups.7%(3/64),3.1%(2/64),7 group 23.4%(15/64),8 group a 9.4%(6/64),9 group 14.0%(9/64),10 group 1.6%(1/64),11 group 10.9%(7/64),12 group a10.9%(7/64).(2)The rate of inferior mediastinal lymph node metastasis was18.8%(12/64).Univariate analysis showed that tumor diameter,the distance of invasion to esophagus ≥2cm,the distance of invasion to stomach ≥4cm,and the depth of invasion(T stage)were the related factors influencing inferior mediastinal lymph node metastasis(P<0.05).Multivariate analysis showed that the distance of invaded esophagus ≥ 2cm was an independent risk factor for mediastinal lymph node metastasis(OR=4.495,95%CI 2.694-37.150,P=0.009).(3)The incidence of lymph node metastasis in the lower part of the stomach was 10.9%(7/64).Univariate analysis showed that tumor diameter,distance between esophagus and esophagus ≥ 2cm,distance between stomach and stomach ≥4cm,depth of invasion(T stage)were the related factors affecting lymph node metastasis in the lower part of the stomach(P<0.05).Multivariate analysis showed that gastric invasion distance ≥4cm was an independent risk factor for lower gastric lymph node metastasis(OR=7.203,95%CI1.423-45.196,P=0.008).(4)The overall lymph node metastasis rate was 45.3%(24/64).Univariate analysis showed that tumor diameter,distance between invasion and esophagus ≥2cm and depth of invasion(T stage)were related risk factors for overall lymph node metastasis(P<0.05).Multivariate analysis showed that: Depth of invasion(T staging)was an independent risk factor for overall lymph node metastasis(OR=4.319,95%CI 1.077-9.376,P=0.002).Conclusion Single-center retrospective data showed that: 1.Since lymph node metastasis of Siewert Ⅱ type adenocarcinoma at the esophagogastric junction is mainly abdominal lymph node metastasis,abdominal lymph node dissection should be emphasized.2.The distance of esophageal invasion ≥ 2cm is an independent risk factor for inferior mediastinal lymph node metastasis.When the distance of esophageal tumor invasion ≥2cm,inferior mediastinal lymph node dissection is recommended,and lymph node dissection through thoracic approach is more thorough.3.The distance of gastric invasion ≥4cm is an independent risk factor for lymph node metastasis in the lower part of the stomach.When the distance of gastric invasion ≥4cm,lymph node dissection in the lower part of the stomach is recommended,and radical total gastrectomy is recommended.4.The depth of invasion(T stage)is an independent risk factor affecting overall lymph node metastasis.For patients with late T stage,more attention should be paid to the thoroughness of lymph node dissection.