Abstract
Esophagogastric junction tumors are a challenging pathology for surgeons and the best treatment depends on an adequate initial localization and stadification. Approximately half of patients relapse after curative surgery during the first two years. Surgical resection could increase the survival of these patients, but the esophageal reconstruction is a surgical challenge for which there are multiple reconstruction techniques described with different organs.In this report, we present the case of a patient with an esophagogastric junction tumor treated initially with total gastrectomy and esophageal margin. The patient presented an anastomotic recurrence that was taken to surgical resection, but a second recurrence required a residual esophagectomy with ileocolonic reconstruction, to achieve adequate oncologic treatment.
Highlights
Despite multiple therapeutic modalities, esophagogastric junction (EGJ) tumors have a poor prognosis, with a five-year survival rate of 8% in 1973 and an increase to 17% in 2008, due to the introduction of neoadjuvant chemoradiotherapy [1]
There are multiple consequences of an inadequate classification of esophagogastric junction tumors. It involves the erroneous choice of surgical approach, and the oncologic treatment, such as the temporal relationship between chemotherapy, radiotherapy, and surgery that depends on a clear topographic understanding and accurate classification of these tumors
Perioperative chemotherapy is the choice for Siewert III tumors and neoadjuvant chemoradiation therapy, such as CROSS, is the choice in Siewert I and II tumors
Summary
Esophagogastric junction (EGJ) tumors have a poor prognosis, with a five-year survival rate of 8% in 1973 and an increase to 17% in 2008, due to the introduction of neoadjuvant chemoradiotherapy [1]. Upper gastrointestinal endoscopy (UGIE) showed a tumor lesion in the EGJ with obstruction, which compromised the entire esophageal circumference from 39 to 44 cm. The pathology result of the resection reported compromise with a moderately differentiated infiltrating intestinal-type adenocarcinoma with free edges and perineural and lymphovascular invasion, in addition to one of four lymph nodes affected by the tumor. In February 2018, the patient presented an elevated CEA again, so a PET-CT was performed that reported an increase in metabolic activity at the site of the last esophageal-jejunal anastomosis, but the UGIE did not show endoluminal tumor relapse and the decision was taken to continue with expectant management. In August 2018, a new PET-CT confirmed relapse in the distal portion of the esophagus and these new findings were presented at a gastrointestinal surgery meeting, where it was decided to perform a three-way esophagectomy with ileocolonic reconstruction.
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