Oesophageal and Esophagogastric Junctional Carcinoma- Management and Outcomes from an Academic Community Centre of Nepal

Abstract

BACKGROUND
 Oesophageal and junctional cancer is an aggressive malignancy with poor prognosis even with multimodality treatment. The true nature of the presentation, management and its outcome is less known in our population. This study was done to provide clinicians with useful information about the disease epidemiology, stage of presentation and clinical picture of the disease in the setting of a developing country.
 METHODS
 All patients managed for oesophageal and esophagogastric junction (EGJ) tumours over six years were retrospectively studied for types and location of the tumour, treatments given and their outcomes.
 RESULTS
 A total of 76 patients, 62 (81.6 %) with the oesophageal and 14 (18.4 %) patients with EGJ carcinoma were included. The mean age was 68.2 years with a male to female ratio of 1.7. The most common tumour location in the oesophagus was the middle third (39.5 %). Siewert type II was the most common EGJ tumour. Squamous cell carcinoma (63.2 %) was the predominant histological type followed by adenocarcinoma (36.8 %). A total of 14 (18.4 %) patients were in stage III disease, 40 (52.6 %) locally advanced unresectable disease (IVA), and the remaining 22 (28.9 %) were having metastasis (stage IVB). Eighteen (23.7 %) patients required feeding jejunostomy as a palliative procedure, and 26 (34.2 %) underwent definitive chemoradiotherapy. Only 10 (13.2 %) patients underwent surgery with curative intent. There was no operative mortality. The mean survival in patients undergoing surgery with curative intent was 26.9 months (range 4-60 months) while the mean survival in the remaining patients was only 11 months (range: 3-18 months).
 CONCLUSIONS
 Squamous cell carcinoma is the predominant type and the middle and upper third are the most common locations of oesophageal carcinoma. Most of the patients present with advanced stage disease with poor survival.