Results of surgical therapy of adenocarcinomas of the Esophagogastric junction according to a standardized surgical resection technique

Aim: The aim of this retrospective analysis was to exclusively present the surgical results of patients with type-I-III adenocarcinomas of the esophagogastric junction thereby providing a basis for comparison with other approaches. Methods: 56 patients with Barrett's carcinomas and 74 patients with cardial and subcardial tumors were operated on and evaluated. The surgical procedure for type-II/III carcinomas was identical: total gastrectomy, omentectomy and splenectomy with lymph node dissection after a combined left thoraco-abdominal incision. Both tumor entities were summarized into 1 group and compared with the results of surgery for Barrett's carcinomas: subtotal esophagectomy and proximal stomach resection with lymph node dissection after right thoracotomy and an additional abdominal incision. Results: In 93% of all patients an R0 resection was possible. In patients with Barrett's carcinomas pulmonal complications (41%) were the predominant postoperative problems. The 30-day lethality (5.3%) was higher in the group of patients with typed carcinomas compared to those with type-II/III carcinomas (1.4%). Tumor infiltration and nodal involvement determined the prognosis after R0 resection. The presence of Barrett's mucosa in typed adenocarcinomas and the histological assessment according to Lauren's classification into type-II/III carcinomas also influenced the long-term prognosis. Conclusion: After R0 resection it is not the tumor location but tumor infiltration, lymph node status and a differentiated histological assessment that determine the prognosis of patients with adenocarcinomas of the esophagogastric junction. Copyright (C) 2002 S. Karger AG, Basel.