title: Total adventitial resection of the cardia: 'optimal local resection' for tumours of the oesophagogastric junction.
abstract: BACKGROUND
  Little is published about the local resection of oesophageal cancers. We adopted the principles of rectal cancer surgery, ie standard surgical dissection techniques as well as standard pathological processing and reporting, and assessed the feasibility of applying them  to oesophagogastric junction (OGJ) cancer.
  
  
  METHODS
  Over a two-year period consecutive patients with invasive cancers of the OGJ were studied. Following staging and neoadjuvant chemotherapy (NAC), a standard dissection defined as a total adventitial resection of the cardia (TARC) was performed.  Standard histopathological processing involved external inking, photographing, transverse slicing and mounting of cut samples on megablocks. Hospital morbidity and mortality as well as survival at five years' follow-up were assessed.
  
  
  RESULTS
  Forty consecutive patients had a TARC for OGJ  carcinoma. Of these, 32 were offered NAC. Introducing TARC did not result in increased morbidity or mortality. Twenty-seven patients (68%) had an R0 resection that was directly related to the tumour stage and significantly related to a response to chemotherapy. Sixteen patients (42%) were  alive five years after their TARC operation.
  
  
  CONCLUSIONS
  Although the adventitia of the OGJ is not as well developed as that of the rectum, TARC can be performed safely as a standardised resection for OGJ cancers. Whereas the R0 rate for early stage tumours is very high, it remains disappointingly  low for T3N1 tumours despite NAC. Improved long-term survival for these advanced tumours will only be achieved with better neoadjuvant and adjuvant therapies.
authors: Guy's and St Thomas' NHS Foundation Trust, London, UK. abrie.botha@gstt.nhs.uk
authors: A J
authors: AJ
authors: Botha
authors: W
authors: W
authors: Odendaal
authors: V
authors: V
authors: Patel
authors: T
authors: T
authors: Watcyn-Jones
authors: U
authors: U
authors: Mahadeva
authors: F
authors: F
authors: Chang
authors: H
authors: H
authors: Deere
mesh_terms: D000328:Adult; D000368:Aged; D000369:Aged, 80 and over; D002299:Cardia / Q000473:pathology / Q000601:surgery*; D059186:Chemoradiotherapy, Adjuvant; D003238:Connective Tissue / Q000601:surgery; D004938:Esophageal Neoplasms / Q000473:pathology / Q000601:surgery*; D016629:Esophagectomy / Q000379:methods*; D004943:Esophagogastric Junction / Q000473:pathology / Q000601:surgery*; D005240:Feasibility Studies; D005260:Female; D005743:Gastrectomy / Q000379:methods*; D006801:Humans; D007902:Length of Stay; D008297:Male; D008875:Middle Aged; D009367:Neoplasm Staging