A clinico-pathological study of the origin of adeno-carcinoma of the mid-thoracic oesophagus and results of surgical resection.
Adenocarcinomas of the mid-thoracic oesophagus are rare, and in a recent review were found to be 93 in 1099 (8.5%) in our series of carcinoma of the oesophagus and cardia. Study was planned to establish the origins of adeno carcinoma in the mid-thoracic oesophagus and to carry out a comparative evaluation of the results of surgery of such tumours derived from different origins.


METHODS
58 patients with adeno carcinoma in the mid-thoracic oesophagus undergoing surgical resection (10% of all resected patients). Protocol of the study: clinical, radiological, endoscopic and intra-operative study together with serial histopathological examination of all resected specimens, follow-up check.


RESULTS
Four types of adenocarcinoma were identified according to their origin judged by the study results. Type 1: in 29 patients (20 males, 9 females) the tumour had risen from the cardia and had extended upwards in one continuous sheet. Type 2: in 16 cases (8 males, 8 females) adeno carcinoma had originated from the stomach within a hiatal hernia and had extended to the "mid" oesophagus. Type 3: 2 patients (1 male, 1 female) had adeno carcinoma in the mid-oesophagus surrounded by squamous epithelium and presumably originated from oesophageal glands. Type 4: in 11 patients (10 males, 1 female) the tumour had clearly risen from columnar epithelial lined oesophagus (Barrett). SURGICAL RESULTS: 2 patients died in hospital and one at home 25 days after operation (total mortality just over 5%). There was no serious morbidity. The long-term results per type were: Type 1: 4 survived 5 years or more, the remainder survived 14 months on average. Type 2: 2 survived 5 years or more, the remainder survived 16 months on average. Type 3: None survived 5 years, 2 survived 10 and 18 months. Type 4: None survived 5 years, 2 average survived was 11 months.


CONCLUSIONS
Only 20% of the adeno carcinoma of the mid-oesophagus are associated with Barrett and these have the worst prognosis after surgical resection.
Moghissi
K
K
Bupa Hospital Hull & East Riding, Hull, N. Humberside, U.K.
Papiri
N
N
D000230:Adenocarcinoma / Q000150:complications / Q000473:pathology* / Q000601:surgery; D000328:Adult; D000368:Aged; D000369:Aged, 80 and over; D001471:Barrett Esophagus / Q000150:complications / Q000473:pathology; D004938:Esophageal Neoplasms / Q000150:complications / Q000473:pathology* / Q000601:surgery; D016629:Esophagectomy / Q000379:methods* / Q000401:mortality; D005260:Female; D006801:Humans; D008297:Male; D008875:Middle Aged; D009367:Neoplasm Staging; D011379:Prognosis; D015996:Survival Rate