Establishing a standard surgery for esophagogastric junction cancer: Final results from the JGCA-JES nationwide prospective study.
prospective_cohort · Level II
Where this comes from
- Record sourced from PubMed, PMID 41707650.
- Also identified by DOI 10.1016/j.xcrm.2026.102627 and PMC identifier 12923963.
- Licence recorded as CC BY.
- The licence permits redistribution, so the abstract is shown in full and the full text is available from the publisher.
Abstract
The optimal surgical approach and extent of lymph node dissection for esophagogastric junction (EGJ) cancer remains uncertain. We conduct a nationwide multicenter prospective study in patients with resectable cT2-T4 adenocarcinoma or squamous cell carcinoma with the tumor epicenter located within 2 cm of the EGJ. Patients undergo subtotal or lower esophagectomy with dissection of all regional lymph nodes. Of 1,065 patients screened, 371 are enrolled before surgery. Final analysis shows that proximal perigastric and suprapancreatic nodes exhibit a high therapeutic efficacy index (TEI), strongly supporting their dissection for improved long-term survival. TEIs in middle and lower para-esophageal stations are higher when esophageal involvement exceeds 3 and 2 cm, respectively. Conversely, all other stations, including distal perigastric and paraaortic nodes, have low TEIs, indicating minimal survival impact. Thus, mediastinal node dissection should be tailored to esophageal involvement length. This study is registered at UMIN Clinical Trials Registry (UMIN000013205).
Medical subject headings
- Esophagogastric Junction
- Esophageal Neoplasms
- Adenocarcinoma
- Carcinoma, Squamous Cell