title: Esophageal Adenocarcinoma: Impact of a Large Hiatal Hernia on Outcomes After Surgery.
abstract: OBJECTIVE
  To evaluate complete tumor resection rate (primary objective), 30-day postoperative outcomes, and survival (secondary objectives) in patients with a hiatal hernia (HH) ≥5 cm (HH group) compared with those who did not have a HH or presented with a HH <5 cm (control group).
  
  
  BACKGROUND
  HH is a risk factor for esophageal and junctional adenocarcinoma (EGJA). Its impact on the outcomes after EGJA surgery is unknown.
  
  
  METHODS
  Among 367 patients who underwent surgery for EGJA, a HH was searched for on computerized tomography scan and barium swallow, with comparison between the HH (n = 42) and control (n = 325) groups.
  
  
  RESULTS
  In the HH group, EGJAs exhibited higher rates of incomplete resection (50.0% vs 4.0%; P < 0.001), of pN3 stages (28.5% vs 10.1%; P = 0.002), and lower median survival (20.9 vs 41.0 mos; P = 0.001). After adjustment, a HH ≥5 cm was a predictor of incomplete resection (odds ratio 21.0, 95% confidence interval 9.4-46.8, P < 0.001) and a poor prognostic factor (hazard ratio 1.6, 95% confidence interval 1.1-2.5, P = 0.025). In the HH group, 30-day mortality was significantly higher in patients who received neoadjuvant radiotherapy (20.0% vs 0%; P = 0.040), which was related to greater cardiac and pulmonary toxicity.
  
  
  CONCLUSIONS
  For the first time, we showed that a HH ≥5 cm is associated with a poor prognosis in patients who had surgery for EGJA, linked to greater incomplete resection and lymph node involvement. Neoadjuvant radiotherapy was associated with a significant toxicity in patients with a HH ≥5 cm.
authors.affiliation: *Univ.Lille, Department of Digestive and Oncological Surgery, Claude Huriez University Hospital, Lille, France†Univ.Lille, URM-S 1172 - JPArc - Centre de Recherche, Jean-Pierre AUBERT Neurosciences et Cancer, Lille, France‡Inserm, UMR-S 1172, Lille, France§Univ.Lille, Department of Pathology, Centre de Biologie et Pathologie, University Hospital, Lille, France¶SIRIC ONCOLille, Lille, France||Univ.Lille, Department of Radiology, Claude Huriez University Hospital, University Hospital, Lille, France**Department of Gastrointestinal Oncology, Oscar Lambret Center, Lille, France††Department of Radiation Oncology, Oscar Lambret Center, Lille, France.
authors.forename: Anne
authors.initials: A
authors.lastname: Gandon
authors.forename: Caroline
authors.initials: C
authors.lastname: Gronnier
authors.forename: Florence
authors.initials: F
authors.lastname: Renaud
authors.forename: Paul
authors.initials: P
authors.lastname: Borde
authors.forename: Marguerite
authors.initials: M
authors.lastname: Vanderbeken
authors.forename: Flora
authors.initials: F
authors.lastname: Hec
authors.forename: Guillaume
authors.initials: G
authors.lastname: Piessen
authors.forename: Antoine
authors.initials: A
authors.lastname: Adenis
authors.forename: Xavier
authors.initials: X
authors.lastname: Mirabel
authors.forename: Christophe
authors.initials: C
authors.lastname: Mariette
mesh_terms: D000230:Adenocarcinoma / Q000150:complications* / Q000401:mortality / Q000601:surgery*; D000328:Adult; D000368:Aged; D000369:Aged, 80 and over; D016022:Case-Control Studies; D003131:Combined Modality Therapy; D004938:Esophageal Neoplasms / Q000150:complications* / Q000401:mortality / Q000601:surgery*; D016629:Esophagectomy; D005260:Female; D006551:Hernia, Hiatal / Q000150:complications*; D006760:Hospitalization; D006801:Humans; D008297:Male; D008875:Middle Aged; D009367:Neoplasm Staging; D015996:Survival Rate; D016896:Treatment Outcome; D055815:Young Adult