Siewert Type I-II Adenocarcinoma of the Esophagus Clinical Trial
Official title:
Siewert Type I and II Esophageal Adenocarcinoma (EAC): CT, PET-CT, EUS Sensitivity / Specificity for the Assessment of Lymph Node Metastases (LNM) in Groups of Thoracic and Abdominal Lymph Nodal Stations
In Siewert type I/II EAC, sensitivity/specificity of CT, PET-CT, EUS for assessment of N descriptor in defined groups of lymph nodes were investigated.
Esophageal adenocarcinoma (EAC) is a disease with poor overall prognosis and rising incidence
in western countries. In patients without organ metastases, therapy is currently based on
surgery with or without neoadjuvant therapy; indication for primary surgery is reserved to
clinical TNM stages 0-IIa, whereas a multimodality approach is more suitable for clinical TNM
stages IIb-III. The operation comprises the resection of distal esophagus and proximal or
total gastrectomy. Two field lymphadenectomy is generally recommended, but the extent of
lymphadenectomy is among the controversial issues, as extensive removal of nodes may cause
significant morbidity and its effect on survival in addition to neoadjuvant therapy is not
clear. Current guidelines are based on the 7th edition of AJCC & UICC TNM classification,
which stages lymph node status (N) according to the number of metastatic nodes, but do not
consider the specific anatomic stations of regional nodes. EAC subtypes are known to
demonstrate different metastatic nodal patterns of spread. They may be classified with the
Siewert's classification according to the position of the tumor with respect to the
esophago-gastric junction (EGJ), or according to histologic parameters like the
presence/absence of intestinal metaplasia in the esophagus and stomach. Siewert Type I EAC,
which fairly corresponds to the Barret's like type according to the presence absence of
intestinal metaplasia, spreads more likely to the thoracic nodal stations, while Siewert Type
II and the pyloric like type, do spread more frequently to the perigastric and celiac
stations. Therefore, an increasing interest is emerging for preoperative mapping of lymph
nodes metastases in order to tailor surgery according to metastatic patterns.
The majority of studies aiming to assess the accuracy of N staging with clinical methods
generally refer to the global evaluation of regional nodes according to the 7th edition of
staging descriptors. Studies reporting specific data on the clinical staging assessment of
specific thoracic and abdominal lymph nodal stations are few, diagnostic tests and results
are not uniform, interpretation and comparison of data within reports is not immediate.
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