A new N category for cancer in the esophagogastric junction based on lymph node compartments

Background. There remains controversy as to which lymph nodes should be or need to be resected to cure patients with a cancer in the esophagogastric junction (EGJ). Methods. A series of 1289 patients with a cancer in the EGJ are reviewed in this study. Cancers in the EGJ were divided in two groups, as esophagus-dominant tumors or stomach-dominant tumors, and the regional lymph nodes of each group were classified into three compartments (N category) using a score obtained by multiplication of the metastatic rate by the 5-year survival rate after lymphadenectomy. Results. The N1 nodes for an esophagus-dominant tumor were the right and left cardiac (1, 2), the lesser curvature (3), the left gastric artery (7), the esophageal hiatus (20), and the lower thoracic paraesophageal nodes (110). The N2 nodes were the anterosuperior group of the common hepatic artery (8a), the celiac (9), the splenic artery (11), the infradiaphragmatic (19), the middle thoracic paraesophageal (108), the right and left pulmonary hilar (109), and the supradiaphragmatic nodes (111). The N3 nodes were the greater curvature (4sa, 4sb, 4d), the suprapyloric and subpyloric (5, 6), the right and left recurrent nerve (106rec), the infracarinal (107), and posterior mediastinal nodes (112). The N1 nodes for a stomach-dominant tumor were the 1, 2, 3, 7, and 20 nodes. The N2 nodes were the 8a, 9, 11, 4sa, 4sb, and 19 nodes. The N3 nodes were the 4d, 5, 6, the posterior group of the common hepatic artery (8p), the splenic hilar (10), the abdominal paraaortic (16a2/b1), 20, 108, 110, 111, and 112 nodes. Conclusions. A new N category for cancer in the EGJ was proposed based on the metastatic rates of the lymph nodes and the survival rates. © 2007 Japan Esophageal Society and Springer-Verlag.