title: Surgical treatment of tumors of the proximal stomach with involvement of the distal esophagus: a 26-year experience with Siewert type III tumors.
abstract: OBJECTIVE
  A paucity of outcome data exists regarding patients with proximal stomach cancer involving the distal esophagus (Siewert type III tumors). This is especially true with regard to long-term survival rates after surgical intervention.
  
  
  METHODS
  Medical records were reviewed of all patients who underwent total gastrectomy and distal esophagectomy with Roux-en-Y esophagojejunostomy for Siewert type III tumors from January 1975 through December 2000.
  
  
  RESULTS
  There were 116 patients (93 men and 23 women). The median age was 66 years (range, 22-87 years). Pathologic stage was 0 (carcinoma in situ) in 1 patient, IB in 13 patients, II in 17 patients, IIIA in 34 patients, IIIB in 10 patients, and IV in 41 patients. Complete resection was achieved in 69 (59.5%) patients. Eleven (9.5%) patients were treated with neoadjuvant therapy, 49 (42.2%) received adjuvant therapy, and 6 (5.2%) received intraoperative radiation. Follow-up was complete in 114 (98.3%) patients, ranging from 1 to 281 months (median, 14 months). Operative mortality was 5.2%. Complications occurred in 51 (43.9%) patients. Clinically significant anastomotic leaks occurred in 15 (12.9%) patients. Median hospitalization was 13 days (range, 8-70 days). Median follow-up was 14 months (range, 1-281 months). Overall median survival was 434 days, with 1-, 5-, and 10-year survivals of 56.2%, 19.0%, and 13.5%, respectively. The only factor associated with increased hospital mortality was anastomotic leakage (P = .002). Incomplete resection, increased tumor stage and grade, and splenic involvement significantly worsened long-term survival.
  
  
  CONCLUSIONS
  Total gastrectomy and distal esophagectomy for Siewert type III tumors is associated with reasonable mortality and significant morbidity. Although often palliative, surgical intervention can provide long-term survival, especially in patients with completely resected, early-stage, low-grade tumors.
authors.affiliation: Division of General Thoracic Surgery, Mayo Clinic College of Medicine, Rochester, Minn 55905, USA.
authors.forename: K Robert
authors.initials: KR
authors.lastname: Shen
authors.forename: Stephen D
authors.initials: SD
authors.lastname: Cassivi
authors.forename: Claude
authors.initials: C
authors.lastname: Deschamps
authors.forename: Mark S
authors.initials: MS
authors.lastname: Allen
authors.forename: Francis C
authors.initials: FC
authors.lastname: Nichols
authors.forename: W Scott
authors.initials: WS
authors.lastname: Harmsen
authors.forename: Peter C
authors.initials: PC
authors.lastname: Pairolero
mesh_terms: D000230:Adenocarcinoma / Q000145:classification / Q000601:surgery*; D000328:Adult; D000368:Aged; D000369:Aged, 80 and over; D004938:Esophageal Neoplasms / Q000145:classification / Q000601:surgery*; D016629:Esophagectomy; D005260:Female; D005743:Gastrectomy; D006801:Humans; D008297:Male; D008875:Middle Aged; D009361:Neoplasm Invasiveness; D013274:Stomach Neoplasms / Q000145:classification / Q000601:surgery*; D013997:Time Factors