Adenocarcinoma of the Esophagogastric Junction: The Role of Abdominal-Transhiatal Resection View Full Text


Ontology type: schema:ScholarlyArticle     


Article Info

DATE

2008-12-03

AUTHORS

Fabio Carboni, Riccardo Lorusso, Roberto Santoro, Pasquale Lepiane, Pietro Mancini, Isabella Sperduti, Eugenio Santoro

ABSTRACT

The surgical strategy for adenocarcinoma of the esophagogastric junction is still controversial. The aim of this study was to evaluate surgical results of the abdominal-transhiatal approach for 100 consecutively operated type II and III cardia adenocarcinoma, to clarify clinicopathological differences between these tumors, and to define prognostic factors. A prospectively maintained database identified 100 consecutively operated patients with Siewert type II and III cardia adenocarcinoma. Survival was analyzed by the Kaplan-Meier method. Differences between subgroups and prognostic factors were evaluated by the log rank test and Cox regression. Concerning clinicopathological characteristics, only the incidence of T1–2 stage was significantly higher in Siewert II type (P = .006). A complete (R0) resection was obtained in 74 patients (74%). Overall postoperative mortality and morbidity rates were 6% and 28%, respectively. Overall actuarial 5-year survival rate in resected patients was 27.4% (median 27 months), with 20.6% for type II and 34 for type III cancers (P = .07). Considering R0 resections, overall actuarial 5-year survival rate was 33.9% (median 33 months), with 26.7% for type II and 40.5 for type III cancer (P = .06). Pathologic T and N stage and R status were independent prognostic factors by multivariate analysis, and Siewert type showed a trend toward significance. The abdominal-transhiatal approach is a safe surgical approach, allowing complete tumor resection and adequate lymphadenectomy in these patients. True carcinoma of the cardia may be a distinct clinical entity with a more aggressive natural history than subcardial gastric carcinoma. More... »

PAGES

304-310

References to SciGraph publications

  • 2002-04-16. The pattern of recurrence of adenocarcinoma of the oesophago-gastric junction in BRITISH JOURNAL OF CANCER
  • 2007-05-19. Impact of Splenectomy in Patients with Gastric Adenocarcinoma of the Cardia in JOURNAL OF GASTROINTESTINAL SURGERY
  • 1998-12. Japanese Classification of Gastric Carcinoma – 2nd English Edition – in GASTRIC CANCER
  • 1998-12. International strategy in the struggle against gastric cancer in GASTRIC CANCER
  • 2004-07. Association of Splenectomy With Postoperative Complications in Patients With Proximal Gastric and Gastroesophageal Junction Cancer in ANNALS OF SURGICAL ONCOLOGY
  • 2003-08-18. Fluorodeoxyglucose-Positron Emission Tomography in Adenocarcinomas of the Distal Esophagus and Cardia in WORLD JOURNAL OF SURGERY
  • 2006-02-13. Clinicopathologic Comparison of Siewert Type II and III Adenocarcinomas of the Gastroesophageal Junction in WORLD JOURNAL OF SURGERY
  • 2003-02-27. Is Adenocarcinoma of the Gastric Cardia a Distinct Entity Independent of Subcardial Carcinoma? in WORLD JOURNAL OF SURGERY
  • 2007-01-30. Spleen Preservation in Radical Surgery for Gastric Cardia Cancer in ANNALS OF SURGICAL ONCOLOGY
  • 2006-09-07. Distinct Recurrence Pattern and Outcome of Adenocarcinoma of the Gastric Cardia in Comparison with Carcinoma of Other Regions of the Stomach in WORLD JOURNAL OF SURGERY
  • 2007-03-08. Impact of Induction Chemotherapy and Preoperative Chemoradiotherapy on Operative Morbidity and Mortality in Patients with Locoregional Adenocarcinoma of the Stomach or Gastroesophageal Junction in ANNALS OF SURGICAL ONCOLOGY
  • Identifiers

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    http://scigraph.springernature.com/pub.10.1245/s10434-008-0247-x

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    DIMENSIONS

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    37 schema:description The surgical strategy for adenocarcinoma of the esophagogastric junction is still controversial. The aim of this study was to evaluate surgical results of the abdominal-transhiatal approach for 100 consecutively operated type II and III cardia adenocarcinoma, to clarify clinicopathological differences between these tumors, and to define prognostic factors. A prospectively maintained database identified 100 consecutively operated patients with Siewert type II and III cardia adenocarcinoma. Survival was analyzed by the Kaplan-Meier method. Differences between subgroups and prognostic factors were evaluated by the log rank test and Cox regression. Concerning clinicopathological characteristics, only the incidence of T1–2 stage was significantly higher in Siewert II type (P = .006). A complete (R0) resection was obtained in 74 patients (74%). Overall postoperative mortality and morbidity rates were 6% and 28%, respectively. Overall actuarial 5-year survival rate in resected patients was 27.4% (median 27 months), with 20.6% for type II and 34 for type III cancers (P = .07). Considering R0 resections, overall actuarial 5-year survival rate was 33.9% (median 33 months), with 26.7% for type II and 40.5 for type III cancer (P = .06). Pathologic T and N stage and R status were independent prognostic factors by multivariate analysis, and Siewert type showed a trend toward significance. The abdominal-transhiatal approach is a safe surgical approach, allowing complete tumor resection and adequate lymphadenectomy in these patients. True carcinoma of the cardia may be a distinct clinical entity with a more aggressive natural history than subcardial gastric carcinoma.
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