Mediastinal Lymph Node Metastasis or Recurrence in Esophagogastric Junction Carcinoma With Esophageal Invasion Length Between 2 and 4 Cm

Background The optimal extent of mediastinal lymph node (LN) dissection for esophagogastric junction (EGJ) cancer with esophageal invasion length (EIL) between 2 and 4 cm remains controversial. In our hospital, the surgical approach, subtotal esophagectomy (SE) with LN dissection extending to the upper mediastinum or lower esophagectomy (LE) with LN dissection extending to the middle or lower mediastinum, was determined according to the presence of LN metastasis and the patient’s general condition. We retrospectively investigated the risk factors for upper and middle mediastinal lymph node (UMMLN) metastasis or recurrence in EGJ cancer with EIL between 2 and 4 cm. Methods Seventy-five patients who underwent radical resection for Stage II-IV EGJ cancer with EIL between 2 and 4 cm between January 2000 and December 2021 in our hospital were included in this study. Thirty-three patients—19 squamous cel carcinoma (SCC) and 14 adenocarcinoma (AC) patients—underwent SE, and 42 patients (20 SCC and 22 AC patients) underwent LE. The rate of UMMLN metastasis or recurrence within 3 years was investigated. Multivariate logistic analysis was used to identify significant factors associated with metastasis or recurrence in UMMLN. Results UMMLN metastases were observed in 19 patients (9 SCC and 10 AC patients). UMMLN recurrences were observed in 7 SCC patients, and the rate of UMMLN recurrence in SCC was significantly higher (p = 0.012). Univariate analysis identified epicenter within the extent from esophagus to EGJ, T staging, N staging, and lymphatic invasion as significant risk factors for UMMLN metastasis or recurrence. Regarding histology, the rate of UMMLN metastasis or recurrence in AC without Barrett’s epithelium was considerably lower, though the difference was not statistically significant (p = 0.067). Multivariable analysis identified epicenter, T staging, and N staging as independent predictors. Conclusion This study demonstrated that considering the position of epicenter as well as TNM staging might be useful in determining the area of mediastinal dissection for EGJ cancer with EIL between 2 and 4 cm. Histology and Barrett’s epithelium might also be potential factors to consider.