title: Total esophagogastrectomy in the neoplasms of the esophagus and esofagogastric junction: when must be indicated?
abstract: OBJECTIVE
  to analyse the indications and results of the total esophagogastrectomy in cancers of the distal esophagus and esophagogastric junction.
  
  
  METHODS
  twenty patients with adenocarcinomas were operated with a mean age of 55 ± 9.9 years (31-70 years), and 14 cases were male (60%). Indications were 18 tumors of the distal esophagus and esophagogastric junction (90%) and two with invasion of gastric fundus (10%) in patients with previous gastrectomy. Preoperative colonoscopy to exclude colonic diseases was performed in ten cases.
  
  
  RESULTS
  the surgical technique consisted of median laparotomy and left cervicotomy, followed by transhiatal esophagectomy associated with D2 lymphadenectomy. The reconstructions were performed with eight esophagocoloduodenoplasty and the others were Roux-en-Y esophagocolojejunoplasty to prevent the alkaline reflux. Three cases were stage I / II, while 15 cases (85%) were stages III / IV, reflecting late diagnosis of these tumors. The operative mortality was 5 patients (25%): a mediastinitis secondary to necrosis of the transposed colon, abdominal cellulitis secondary to wound infection, severe pneumonia, an irreversible shock and sepsis associated with colojejunal fistula. Four patients died in the first year after surgery: 3 (15%) were due to tumor recurrence and 1 (5%) secondary to bronchopneumonia. The 5-year survival was 15%.
  
  
  CONCLUSIONS
  the total esophagogastrectomy associated with esophagocoloplasty has high morbidity and mortality, requiring precise indication, and properly selected patients benefit from the surgery, with the risk-benefit acceptable, contributing to increased survival and improved quality of life.
authors.affiliation: Faculdade de Ciências Médicas, Universidade Estadual de Campinas, Campinas, São Paulo, Brasil.
authors.forename: Nelson Adami
authors.initials: NA
authors.lastname: Andreollo
authors.affiliation: Faculdade de Ciências Médicas, Unicamp, Campinas, São Paulo, Brasil.
authors.forename: João de Souza
authors.initials: Jde S
authors.lastname: Coelho Neto
authors.affiliation: Faculdade de Ciências Médicas, Universidade Estadual de Campinas, Campinas, São Paulo, Brasil.
authors.forename: Guilherme Delfino
authors.initials: GD
authors.lastname: Calomeni
authors.affiliation: Faculdade de Ciências Médicas, Universidade Estadual de Campinas, Campinas, São Paulo, Brasil.
authors.forename: Luiz Roberto
authors.initials: LR
authors.lastname: Lopes
authors.affiliation: Faculdade de Ciências Médicas, Universidade Estadual de Campinas, Campinas, São Paulo, Brasil.
authors.forename: Valdir
authors.initials: V
authors.lastname: Tercioti Junior
mesh_terms: D000230:Adenocarcinoma / Q000601:surgery*; D000368:Aged; D004938:Esophageal Neoplasms / Q000601:surgery*; D016629:Esophagectomy; D004943:Esophagogastric Junction; D005260:Female; D005743:Gastrectomy; D006801:Humans; D008297:Male; D008875:Middle Aged; D009364:Neoplasm Recurrence, Local; D011788:Quality of Life