Is gastric tube reconstruction the optimal surgical procedure for Siewert type II esophagogastric junction carcinoma?

To evaluate the potential risk of gastric tube reconstruction for Siewert type II esophagogastric junction carcinoma. We retrospectively analyzed clinicopathological and survival data of 41 patients who had undergone total gastrectomy for Siewert type II carcinoma, focusing on lymph node metastasis around the middle to lower greater curvature or parapyloric area. Histological examination showed involvement of at least one lymph node in six patients (14%). Multivariate Cox proportional hazard regression analysis of seven clinicopathological variables showed that lymph node metastasis around the middle to lower greater curvature, or parapyloric area was the only significant independent unfavorable factor (odds ratio=6.62; 95% confidence interval=1.27-41.1; p=0.03) for survival. We identified no significant predictors of lymph node metastasis in analyzed patients. From an oncological point of view, we do not recommend routine gastric tube reconstruction for Siewert type II carcinoma.