Results of surgical therapy of adenocarcinomas of the esophagogastric junction according to a standardized surgical resection technique.
OBJECTIVE
The aim of this retrospective analysis was to exclusively present the surgical results of patients with type-I-III adenocarcinomas of the esophagogastric junction thereby providing a basis for comparison with other approaches.


METHODS
56 patients with Barrett's carcinomas and 74 patients with cardial and subcardial tumors were operated on and evaluated. The surgical procedure for type-II/III carcinomas was identical: total gastrectomy, omentectomy and splenectomy with lymph node dissection after a combined left thoraco-abdominal incision. Both tumor entities were summarized into 1 group and compared with the results of surgery for Barrett's carcinomas: subtotal esophagectomy and proximal stomach resection with lymph node dissection after right thoracotomy and an additional abdominal incision.


RESULTS
In 93% of all patients an R0 resection was possible. In patients with Barrett's carcinomas pulmonal complications (41%) were the predominant postoperative problems. The 30-day lethality (5.3%) was higher in the group of patients with type-I carcinomas compared to those with type-II/III carcinomas (1.4%). Tumor infiltration and nodal involvement determined the prognosis after R0 resection. The presence of Barrett's mucosa in type-I adenocarcinomas and the histological assessment according to Lauren's classification into type-II/III carcinomas also influenced the long-term prognosis.


CONCLUSIONS
After R0 resection it is not the tumor location but tumor infiltration, lymph node status and a differentiated histological assessment that determine the prognosis of patients with adenocarcinomas of the esophagogastric junction.
Meyer
W
W
Department of Abdominal, Thoracic and Endocrine Surgery, Klinikum Nürnberg-Nord, Nuremberg, Germany.
Popp
M
M
Klinger
L
L
Awad-Allah
A
A
Gebhardt
C
C
D000230:Adenocarcinoma / Q000473:pathology / Q000601:surgery*; D002299:Cardia; D004938:Esophageal Neoplasms / Q000473:pathology / Q000601:surgery*; D016629:Esophagectomy; D004943:Esophagogastric Junction; D005260:Female; D005743:Gastrectomy; D006801:Humans; D008197:Lymph Node Excision; D008297:Male; D008875:Middle Aged; D009367:Neoplasm Staging; D011379:Prognosis; D012189:Retrospective Studies; D013274:Stomach Neoplasms / Q000473:pathology / Q000601:surgery*; D016896:Treatment Outcome