Clinicopathologic comparison of Siewert type II and III adenocarcinomas of the gastroesophageal junction.
BACKGROUND
Since Misumi et al. and Siewert proposed a new classification for carcinoma of the gastroesophageal junction (GEJ), few surgical studies using these criteria have been reported from Eastern countries. Siewert type II adenocarcinomas are managed using general rules for either gastric or esophageal cancer. We set out to determine whether type II adenocarcinoma is a distinct clinical entity requiring a more specific treatment plan.


METHODS
Among 125 Japanese patients who underwent resection of adenocarcinoma of the GEJ (type I, 2; type II, 44; type III, 79), 101 who underwent R0 resections (type II, 40; type III, 61) were analyzed to evaluate surgical results and compare clinicopathologic factors.


RESULTS
Barrett's epithelium was recognized in two patients with type II adenocarcinoma. Type II differed significantly from type III in higher prevalence of Borrmann macroscopic type 2, more frequent lymph node metastasis (58% vs. 34%), higher metastatic rate to lower mediastinal lymph nodes (13%), increased risk of hepatic recurrence, and lower 5-year survival after R0 resection (67.4% vs. 87.1%).


CONCLUSIONS
Clinicopathologic differences were evident between type II and III adenocarcinomas. Siewert type II adenocarcinoma differs sufficiently to be considered a clinical entity distinct and independent from type III.
Division of Surgical Oncology, Department of Surgery, Nagoya University Graduate School of Medicine, 65, Tsurumai-cho, Showa-ku, Nagoya, 466-8550, Japan. nyuasa@med.nagoya-u.ac.jp
Norihiro
N
Yuasa
Hideo
H
Miyake
Tatsuharu
T
Yamada
Tomoki
T
Ebata
Yuji
Y
Nimura
Tatsuo
T
Hattori
D000230:Adenocarcinoma / Q000453:epidemiology / Q000473:pathology* / Q000601:surgery; D000328:Adult; D004938:Esophageal Neoplasms / Q000453:epidemiology / Q000473:pathology* / Q000601:surgery; D004943:Esophagogastric Junction / Q000473:pathology* / Q000601:surgery; D005260:Female; D006801:Humans; D007564:Japan / Q000453:epidemiology; D008207:Lymphatic Metastasis; D008297:Male; D018709:Statistics, Nonparametric; D013274:Stomach Neoplasms / Q000453:epidemiology / Q000473:pathology* / Q000601:surgery; D016019:Survival Analysis