title: Adenocarcinoma of the esophagogastric junction: the role of abdominal-transhiatal resection.
abstract: The surgical strategy for adenocarcinoma of the esophagogastric junction is still controversial. The aim of this study was to evaluate surgical results of the abdominal-transhiatal approach for 100 consecutively operated type II and III cardia adenocarcinoma, to clarify clinicopathological differences between these tumors, and to define prognostic factors. A prospectively maintained database identified 100 consecutively operated patients with Siewert type II and III cardia adenocarcinoma. Survival was analyzed by the Kaplan-Meier method. Differences between subgroups and prognostic factors were evaluated by the log rank test and Cox regression. Concerning clinicopathological characteristics, only the incidence of T1-2 stage was significantly higher in Siewert II type (P = .006). A complete (R0) resection was obtained in 74 patients (74%). Overall postoperative mortality and morbidity rates were 6% and 28%, respectively. Overall actuarial 5-year survival rate in resected patients was 27.4% (median 27 months), with 20.6% for type II and 34 for type III cancers (P = .07). Considering R0 resections, overall actuarial 5-year survival rate was 33.9% (median 33 months), with 26.7% for type II and 40.5 for type III cancer (P = .06). Pathologic T and N stage and R status were independent prognostic factors by multivariate analysis, and Siewert type showed a trend toward significance. The abdominal-transhiatal approach is a safe surgical approach, allowing complete tumor resection and adequate lymphadenectomy in these patients. True carcinoma of the cardia may be a distinct clinical entity with a more aggressive natural history than subcardial gastric carcinoma.
authors.affiliation: Department of Digestive Surgery, Regina Elena Cancer Institute, Rome, Italy. fabiocarb@tiscali.it
authors.forename: Fabio
authors.initials: F
authors.lastname: Carboni
authors.forename: Riccardo
authors.initials: R
authors.lastname: Lorusso
authors.forename: Roberto
authors.initials: R
authors.lastname: Santoro
authors.forename: Pasquale
authors.initials: P
authors.lastname: Lepiane
authors.forename: Pietro
authors.initials: P
authors.lastname: Mancini
authors.forename: Isabella
authors.initials: I
authors.lastname: Sperduti
authors.forename: Eugenio
authors.initials: E
authors.lastname: Santoro
mesh_terms: D000230:Adenocarcinoma / Q000473:pathology / Q000601:surgery*; D000328:Adult; D000368:Aged; D000369:Aged, 80 and over; D002299:Cardia / Q000473:pathology / Q000601:surgery; D013505:Digestive System Surgical Procedures; D004943:Esophagogastric Junction / Q000473:pathology / Q000601:surgery*; D005260:Female; D006801:Humans; D008198:Lymph Nodes / Q000473:pathology / Q000601:surgery; D008207:Lymphatic Metastasis; D008297:Male; D008875:Middle Aged; D009361:Neoplasm Invasiveness; D009367:Neoplasm Staging; D011379:Prognosis; D011446:Prospective Studies; D013274:Stomach Neoplasms / Q000473:pathology / Q000601:surgery*; D015996:Survival Rate; D016896:Treatment Outcome