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Surgical Treatment of Adenocarcinomas of the Gastro-esophageal Junction

  • Gastrointestinal Oncology
  • Published:
Annals of Surgical Oncology Aims and scope Submit manuscript

Abstract

Background

Patients with adenocarcinoma of the gastro-esophageal junction (GEJ) may undergo either esophagectomy or gastrectomy. The aim of this study was to evaluate the outcome of surgical therapy with regard to postoperative outcome and survival in patients with Siewert type II tumors.

Methods

A prospective database of 266 consecutive patients with surgically resectable GEJ adenocarcinomas from 2003 to 2013 was analyzed. The surgical approach was based on preoperative imaging and intraoperative findings.

Results

According to the histopathological analysis, 67 patients (25 %) had type I tumor, 176 patients (66 %) had type II tumor, and 16 patients (6 %) had type III tumor. In total, 86 % were treated with esophagectomy and 14 % with gastrectomy. Overall 5-year survival was 38 %. In type II patients, the type of operation did not significantly influence overall survival on multivariate analysis (p = 0.606). A positive circumferential resection margin (CRM) at the site of the esophagus was more common with gastrectomy (29 vs. 11 %; p = 0.025). No significant differences in mortality, morbidity, or disease recurrence were found. In patients with type II tumors, upper mediastinal nodal involvement (subcarinal, paratracheal, and aortapulmonary window) was found in 11 % of the patients. In 34 % of patients treated with esophagectomy, paraesophageal lymph nodes metastases were harvested compared with 5 % of patients treated with gastrectomy.

Conclusions

In patients with a type II GEJ adenocarcinoma, a positive CRM was more common with gastrectomy. Esophagectomy provides for a more complete para-esophageal lymphadenectomy. Furthermore, the high prevalence of mediastinal nodal involvement indicates that a full lymphadenectomy of these stations should be considered.

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Authors and Affiliations

  1. Department of Surgery, University Medical Center Utrecht, Utrecht, The Netherlands

    K. Parry MD, L. Haverkamp MD, J. P. Ruurda MD, PhD & R. van Hillegersberg MD, PhD

  2. Department of Radiology, University Medical Center Utrecht, Utrecht, The Netherlands

    R. C. G. Bruijnen MD

  3. Department of Gastroenterology and Hepatology, University Medical Center Utrecht, Utrecht, The Netherlands

    P. D. Siersema MD, PhD

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  1. K. Parry MD
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  2. L. Haverkamp MD
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  3. R. C. G. Bruijnen MD
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  6. R. van Hillegersberg MD, PhD
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Correspondence to R. van Hillegersberg MD, PhD.

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Parry, K., Haverkamp, L., Bruijnen, R.C.G. et al. Surgical Treatment of Adenocarcinomas of the Gastro-esophageal Junction. Ann Surg Oncol 22, 597–603 (2015). https://doi.org/10.1245/s10434-014-4047-1

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  • DOI: https://doi.org/10.1245/s10434-014-4047-1

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