Surgical therapy of adenocarcinoma of the esophagogastric junction: analysis of prognostic factors.
OBJECTIVE
The surgical strategy of adenocarcinoma of the esophagogastric junction (EGJ) is still controversial. This study aims at analyzing our surgical results about these lesions in order to define the prognostic factors.


METHODS
From January 1987 to March 2003, 113 patients with adenocarcinoma of the cardia underwent resection in the authors' institution: 19 patients (16.8%) had type I tumors, 35 (30.9%) type II and 59 (52.2%) type III. The treatment was esophagectomy for type I tumors, and extended gastrectomy and distal esophagectomy for type II and III lesions. Morbidity, mortality and the survival rate were determined retrospectively.


RESULTS
Primary resection was performed in 113 patients out of 150 (75.3%). Mortality and morbidity rates were 7.96 and 38.05% respectively. The overall 3- and 5-year survival rates were 35.1 and 26.3% respectively. Survival rates were significantly associated with R0 resection (P<0.001), pathological node-positive category (P<0.001) and tumor differentiation (P=0.0228).


CONCLUSIONS
The prognosis of adenocarcinoma of the EGJ is still unfavorable, but the true prognostic factors are complete macroscopic and microscopic tumor resection, pN category and tumor differentiation. Although the surgical approach does not influence the survival rate, the transhiatal way still remains the best one due to the lower incidence of respiratory morbidity and thoracic pain.
Di Martino
Natale
N
VIII Service of General Surgery and Gastroenterological Physiopathology, Second University of Study of Naples, Italy. natale.dimartino@unina2.it
Izzo
Giuseppe
G
Cosenza
Angelo
A
Cerullo
Guido
G
Torelli
Francesco
F
Monaco
Luigi
L
Basciotti
Anthony
A
del Genio
Alberto
A
D000230:Adenocarcinoma / Q000401:mortality / Q000473:pathology / Q000601:surgery*; D000368:Aged; D002299:Cardia / Q000601:surgery*; D016629:Esophagectomy; D004943:Esophagogastric Junction / Q000601:surgery*; D005260:Female; D005500:Follow-Up Studies; D005743:Gastrectomy; D006801:Humans; D008197:Lymph Node Excision; D008297:Male; D008875:Middle Aged; D011379:Prognosis; D012189:Retrospective Studies; D013274:Stomach Neoplasms / Q000401:mortality / Q000473:pathology / Q000601:surgery*; D015996:Survival Rate