Primary Rectal Lymphoma Responding to Chemotherapy as Sole Treatment: A Case Report

Abstract

To define the clinicopathologic profile, management, and outcomes of esophagogastric junction (EGJ) adenocarcinoma in a Philippine tertiary hospital setting. Data were obtained for 88 patients who had curative surgery for EGJ adenocarcinoma from 2004-2013 in Philippine General Hospital. Student's t-tests, analysis of variance, Chi-square and Fisher’s exact tests were used for comparisons and Cohen’s kappa index for correlation. P ≤ .05 was considered significant. Patients were 81.2% male with mean age 55.2 years. 8% were clinical Siewert type I, 23.9% type II, 15.9% type III, and 52.3% unknown. Surgical approach and resection differed across Siewert types (P <.000). Thoracoabdominal approach (72.7%) and total gastrectomy with distal esophagectomy (77.3%) were most commonly performed. Many had at least pathologic T3 (80.6%), N2 (54.5%), and stage III (68.2%) disease. Neoadjuvant and adjuvant chemotherapy were given to 1.2% (1/82) and 48.6% (18/37) of patients. In-hospital morbidity and mortality rates were 40% and 4.5%. 1-year disease-free and overall survival rates were 69.4% and 76.5%. Correlation was fair between preoperative and pathologic Siewert type (P = .003) and poor between clinical and pathologic stage (P = .115). Patients with recurrence had higher pathologic lymph nodes (P = .029) and stage (P = .022). EGJ adenocarcinomas were frequently locally advanced at presentation and associated with poor outcomes. Surgery should be individualized and multimodality approach considered.