Adenocarcinomas of the esophagogastric junction: How does surgeon’s assessment influence the fate of patients?

Abstract

92 Background: Due to controversial staging systems, classifying tumors of the esophagogastric junction (EGJ) and the choice of the following surgical therapy remains a delicate affair. Methods: In this study the impact of the preoperative surgical-clinical assessment concerning assorting tumors of the EGJ was evaluated in correlation to the patient’s outcome. We analyzed clinicopathological data from 92 patients who were pre- and intraoperatively classified as distal esophageal cancer (Type I) and thus underwent esophagectomy with gastric tube reconstruction and who afterwards (final histology) in part turned out to be cardia/gastric cancers (Type II). Results: Patients with Type II cancers showed significantly more frequent lymphonodal metastasis (p=0.022) and higher recurrence rates (p=0.01), especially distant metastatic recurrence (p=0.03). Cancer-related death was also significantly higher (p=0.002) and recurrence-free survival was significantly shorter (median: 22 vs. 57 months, p=0.027). Also the thoracoabdominal approach (TA) had a favourable influence on patients’ outcome compared to the transhiatal approach (TH). Conclusions: The correct preoperative assessment of tumors of the EGJ and the appropriate surgical therapy are crucial for the outcome of the patient. Those patients with Type II cancers might experience a survival benefit by undergoing radical combined esophago (-hemi)gastrectomy with colon interposition.