Review Status and prognosis of lymph node metastasis in patients with cardia cancer e A systematic review Cecilie Okholm * , Lars Bo Svendsen, Michael P. Achiam Department of Surgical Gastroenterology, Rigshospitalet, University of Copenhagen, Blegdamsvej 9, 2100 København Ø, Denmark article info Article history: Accepted 1 June 2014 Keywords: Adenocarcinoma Cardia cancer Gastroesophageal junction Lymphadenectomy Lymph node metastasis Prognosis abstract Background: Adenocarcinoma of the gastroesophageal junction (GEJ) has a poor prognosis and survival rates significantly decreases if lymph node metastasis is present. An extensive lymphadenectomy may increase chances of cure, but may also lead to further postoperative morbidity and mortality. Therefore, the optimal treatment of cardia cancer remains controversial. A systematic review of English publications dealing with adenocarcinoma of the cardia was conducted to elucidate patterns of nodal spread and prognostic implications. Methods: A systematic literature search based on PRISMA guidelines identifying relevant studies describing lymph node metastasis and the associated prognosis. Lymph node stations were classified according to the Japanese Gastric Cancer Association guidelines. Results: The highest incidence of metastasis is seen in the nearest regional lymph nodes, station no. 1e3 and additionally in no. 7, 9 and 11. Correspondingly the best survival is seenwhen metastasis remain in the most locoregional nodes and survival equally tends to decrease as the metastasis become more distant. Furthermore, the presence of lymph node metastasis significantly correlates to the TNM-stage. Incidences of metastasis in mediastinal lymph nodes are associated with poor survival. Conclusion: The best survival rates is seen when lymph node metastasis remains locoregional and sur- vival rates decreases when distant lymph node metastasis is present. The dissection of locoregional lymph nodes offers significantly therapeutic benefit, but larger and prospective studies are needed to evaluate the effect of dissecting distant and mediastinal lymph nodes. © 2014 Elsevier Ltd. All rights reserved. Contents Introduction ...................................................................................................................... 141 Materials and methods ............................................................................................................ 141 Search strategy ................................................................................................................. 141 Eligibility criteria ............................................................................................................... 141 Classifications of cardia cancer ...................................................................................................... 141 Siewert's classification .......................................................................................................... 141 Classifications of lymph node stations ................................................. ........................................... 142 The Japanese Gastric Cancer Association ........................................................................................ 142 Results .................................................................. ........................................................ 142 Pattern of nodal spread in cardia cancer ................................................ .......................................... 142 Five-year survival related to each lymph node station .......................................... .................................... 143 Additional findings ............................................................................................................. 143 Discussion ....................................................................................................................... 144 Morbidity and mortality related to D1/D2 dissection .......................................... ..................................... 144 Number of lymph nodes removed . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . .. . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . 144 * Corresponding author. Tel.: þ45 25114720. E-mail address: okholmcecilie@gmail.com (C. Okholm). Contents lists available at ScienceDirect Surgical Oncology journal homepage: www.elsevier.com/locate/suronc http://dx.doi.org/10.1016/j.suronc.2014.06.001 0960-7404/© 2014 Elsevier Ltd. All rights reserved. Surgical Oncology 23 (2014) 140e146