title: Management of adenocarcinoma extending to the middle and upper part of the esophagus.
abstract: Of 30 patients with adenocarcinoma of the gastroesophageal junction treated between 1977 and 1982, 11 had tumor spread to the middle or upper thirds of the esophagus. Ten were treated with esophagogastrectomy by the Lewis approach, with two operative deaths. All of the tumors had spread to the periesophageal tissues. The eight surviving patients had relief of dysphagia. Five died with recurrent tumor after a mean survival time of 11 months; three are alive at five and 16 months (without evidence of disease) and 13 months (with recurrence). Adjuvant preoperative radiation therapy was used in four patients, three of whom received concomitant total parenteral nutrition. Despite the poor prognosis of this particularly unfavorable subset of patients with tumors of the gastroesophageal junction, operative resection provides acceptable palliation. Further study of adjuvant modalities is needed.
mesh_terms: D000230:Adenocarcinoma / Q000532:radiotherapy / Q000601:surgery / Q000628:therapy*; D000368:Aged; D003131:Combined Modality Therapy; D004938:Esophageal Neoplasms / Q000532:radiotherapy / Q000601:surgery / Q000628:therapy*; D004943:Esophagogastric Junction; D006801:Humans; D008297:Male; D008875:Middle Aged; D009364:Neoplasm Recurrence, Local / Q000401:mortality; D010166:Palliative Care; D010289:Parenteral Nutrition, Total; D011379:Prognosis; D013997:Time Factors