Evidence map›Paper›PMID 39080133›Full record

ArticleAnnals of surgical oncology2024

The Impact of D2 Versus D1 Lymphadenectomy in Siewert II Gastroesophageal Junction (GEJ) Cancer.

Nathan J Alcasid, Deanna Fink, Kian C Banks, Cynthia J Susai, Katherine Barnes, Rachel Wile, Angela Sun, Ashish Patel, Simon Ashiku, Jeffrey B Velotta

Erratum issuedAbstract readComparative Study
PubMed Full text at PMC Publisher
In one paragraph

Article in Annals of surgical oncology, 2024. The graph could read no effect estimate from its abstract, so it casts no vote on the map. An erratum has been issued. Cited by 5 papers.

0numbers the graph read from it
0cells of the map it votes in
5citing papers in PubMed
–field-weighted citation impact
1 · What the graph read from it

What it found

Each row is one number read from the abstract, on the scale the paper reported it, with its interval. Left of the dashed line favours the treatment, right favours the comparator. Under each row is the sentence it came from. New to these charts? A ten-minute tutorial.

The abstract states no effect estimate the extractor could read, or names no intervention and outcome on the map, so this paper lights no cell and moves no belief. It is still indexed, cited and linked below.

2 · The registry

The trial behind it

Trials whose registry record cites this paper, or whose number appears in the abstract. A trial that started after this paper was published is citing it as background, not reporting it.

Neither the registry nor the abstract names a trial number. If this is a trial report, that itself is worth knowing.

3 · Its place in the literature

Who cites it

5 citing papers in PubMed.

  1. Article
  2. Article
  3. Article
  4. Review
  5. Article
4 · The record

Corrections and comments

5 · Who and what money

Authors and funding

10 authors.

Nathan J AlcasidDepartment of General Surgery, University of California, San Francisco-East Bay, Oakland, CA, USA. Nathan.alcasid@ucsf.edu.
Deanna FinkDivision of Research, Kaiser Permanente Northern California, Oakland, CA, USA.
Kian C BanksDepartment of General Surgery, University of California, San Francisco-East Bay, Oakland, CA, USA.
Cynthia J SusaiDepartment of General Surgery, University of California, San Francisco-East Bay, Oakland, CA, USA.
Katherine BarnesDivision of Thoracic Surgery, Department of Surgery, Kaiser Permanente Northern California, Oakland, CA, USA.
Rachel WileDivision of Thoracic Surgery, Department of Surgery, Kaiser Permanente Northern California, Oakland, CA, USA.
Angela SunDivision of Thoracic Surgery, Department of Surgery, Kaiser Permanente Northern California, Oakland, CA, USA.
Ashish PatelDivision of Thoracic Surgery, Department of Surgery, Kaiser Permanente Northern California, Oakland, CA, USA.
Simon AshikuDivision of Thoracic Surgery, Department of Surgery, Kaiser Permanente Northern California, Oakland, CA, USA.
Jeffrey B VelottaDivision of Thoracic Surgery, Department of Surgery, Kaiser Permanente Northern California, Oakland, CA, USA.

Funding

No grant is acknowledged in the PubMed record.

6 · The paper itself

Abstract

backgroundAlthough multiple treatment options exist for gastroesophageal junction (GEJ) cancer, surgery remains the mainstay for potential cure. Extended nodal dissection with a D2 lymphadenectomy (LAD) remains controversial for Siewert II GEJ cancer. Although D2 LAD may lead to a greater lymph node harvest, its effect on survival remains elusive. The authors hypothesized that additional D2 dissection in Siewert II GEJ cancer does not lead to increased survival.

methodsThis study reviewed Siewert II patients who received a D1 or D2 LAD in addition to minimally invasive esophagectomy (MIE) after receiving neoadjuvant chemoradiation or perioperative chemotherapy (2012-2022). The patients were followed for up to 5 years. The outcomes measured were survival, number of nodes sampled, and operative time. The association between D1 or D2 LAD and overall survival was analyzed with Kaplan-Meier methods and a multivariable Cox regression model.

resultsAmong 155 patients, 74 % underwent D1 and 26 % underwent D2 LAD. The patients with D2 had more than 15 lymph nodes harvested more frequently than those who had D1 (83 % vs 48 %; p < 0.001), with no difference in positive nodes (2.8 ± 5.2 vs 2.1 ± 4.2; p = 0.4). The patients with D2 LAD had a longer median operative time than those who with D1 LAD (362 vs 244 min; p < 0.001). In Kaplan-Meier and multivariable Cox regression models, overall survival did not differ significantly between the patients undergoing D2 and those who had D1 (adjusted hazard ratio [aHR], 0.52; 95 % confidence interval [CI], 0.25-1.00; p = 0.067).

conclusionsLittle consensus exists regarding the optimal lymph node harvest for GEJ cancers. In Siewert II cancer, D2 LAD may not be mandatory and may lead to increased operative morbidity with no significant difference in survival.

Indexed as

Esophageal NeoplasmsEsophagectomyEsophagogastric JunctionLymph Node ExcisionStomach NeoplasmsAdenocarcinomaAgedCarcinoma, Squamous CellFemaleFollow-Up StudiesHumansLymph NodesMaleMiddle AgedNeoadjuvant TherapyPrognosisGastro-esophageal cancerGastro-esophageal junctionLymphadenectomyMinimally invasive esophagectomyStaging

Identifiers

PMID39080133
PMCPMC11467080

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Registered trials

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Read under generation 80e0d062 · epoch 390. Bibliography from PubMed, PubMed Central and OpenAlex; grants from NIH RePORTER; trial links from ClinicalTrials.gov; estimates, votes and beliefs from the OpenQuestion graph.