Proximal gastrectomy for adenocarcinoma of the gastroesophageal junction in a selected set of patients − immediate and long-term results
Authors:
R. Vrba 1; R. Aujeský 1; Č. Neoral 1; M. Stašek 1; M. Loveček 1; J. Tesaříková 1; K. Vomáčková 1; M. Horáková 2; J. Zapletalová 3
Authors place of work:
Chirurgická klinika FN Olomouc
přednosta: prof. MUDr. Č. Neoral, CSc.
1; Oddělení IPCHO FN Olomouc
přednosta: MUDr. L. Blahut
2; Katedra biofyziky LF Univerzity Palackého v Olomouci
přednosta: prof. RNDr. H. Kolářová, CSc.
3
Published in the journal:
Rozhl. Chir., 2016, roč. 95, č. 12, s. 439-443.
Category:
Original articles
Summary
Introduction:
The authors present the results of surgical resection in the form of proximal gastrectomy in a selected set of patients with adenocarcinoma of the gastroesophageal junction. The selection criteria included: ASA III–IV, internal comorbidities and elderly patients.
Methods:
Between 2007 and 2015, 28 patients with adenocarcinoma of the gastroesophageal junction underwent proximal gastrectomy at the 1st Department of Surgery. The patient set consisted of 19 (67.8%) men and 9 (32.3%) women aged 52−89 years with the median age of 72.5 years. Endoscopic examination revealed a tumour of the gastroesophageal junction, which was evaluated according to the Siewert classification: type I was present in 4 (16.7%) cases, type II in 12 (42.3%), and type III in 12 (42.3%). Histological analysis revealed adenocarcinoma in all cases. Proximal gastrectomy with lymphadenectomy was performed in all patients. Splenectomy was performed in eleven patients. The continuity of the gastrointestinal tract was ensured by esophagogastroanastomosis, and pyloromyotomy was performed as a standard procedure. Cryostatic examination revealed positive resection margins in the esophagus in five patients, which led to the resection of the distal esophagus from the right-sided thoracotomy.
Results:
Injury to the biliary tract was observed in one case in the perioperative period, which was treated by hepaticojejunoanastomosis onto an excluded jejunal loop. The following complications were observed postoperatively: bleeding, respiratory complications, anastomotic dehiscence, laparotomy wound dehiscence, and inflammatory infiltration in the abdominal cavity. Thirty-day mortality was 10.7% in our patient set.
Conclusion:
Proximal gastrectomy with lymphadenectomy is an appropriate alternative for polymorbid patients with adenocarcinoma of the gastroesophageal junction and provides good short- and long-term results.
Key words:
cancer of gastroesophageal junction − proximal gastrectomy − complications of therapy
Zdroje
1. Stein HJ, Feith M, Siewert JR. Cancer of the esophagogastric junction. Surgical Oncology 2000;9:35−41.
2. Devesa SS, Blot WJ, Fraumeni JF, Jr. Changing patterns in the incidence of esophageal and gastric carcinoma in the United States. Cancer 1998;83:2049−53.
3. Lagergren J, Bergstrom R, Lindgren A, et al. Symptomatic gastroesophageal reflux as a risk factor for esophageal adenocarcinoma. N Engl J Med 1999;340:825−31.
4. Rahden BH, Stein HJ, Siewert JR. Surgical management of esophagogastric junction tumors. World J Gastroenterol 2006;12:6608−13.
5. Mariette C, Castel B, Balon JM, et al. Extend of esophageal resection for adenocarcinoma of the esophagogastric junction. Eur J Surg Oncol 2003;29:588−93.
6. Feith M, Stein HJ, Siewert JR. Pattern of lymphatic spred of Barretts cancer. World J Surg 2003;27:1052−57.
7. Mine S, Sano T, Hiki N, et al. Thoracic lymph node involment in adenocarcinoma of the esophagogastric junction and lower esophageal squamous cell carcinoma relative to location of the proximal end of the tumor. Ann Surg Oncol 2014;21:1596−601.
8. Graham AJ, Finley RJ, Clifton JC, et al. Surgical management of adenocarcinoma of the cardia. Am J Surg 1998;175:418−21.
9. Soetikno R, Kaltenbach T, Yeh R, et al. Endoscopic mucosal resection for early cancer of the upper gastrointestinal tract. J Clin Oncol 2005;23:4490−8.
10. Sanomur Y, Oka S, Tanaka S, et al. Clinical validity of endoscopic submucosal dissection for submucosal invasive gastric cancer: a single-center study. Gastric cancer 2012;15:97−105.
11. Furukawa H, Hiratsuka M, Imaoka S, et al. Limited surgery for early gastric cancer in cardia. Annals of Surgical Oncology 1998;5:338−41.
12. Allum WH, Blazeby JM, Griffin SM, et al. Guidelines for management of esophageal and gastric cancer. Gut 2011;60:1449−72.
13. Ajani JA, Bentrem DJ, Besh S, et al. Gastric cancer, version2.2013: featured updates to NCCN guidelines. J Natl Compr Canc Netw 2013;11:531−46.
14. Lorenzen S, Blank S, Lordick F, et al. Prediction of response and prognosis by a score including only pretheraupeutic parameters in 410 neoadjuvant treated gastric cancer patiens. Ann Surg Oncol 2012;19:2119−27.
15. Walsh T, et al. A comparison of multimodal therapy and surgery for esophageal adenocarcinoma. N Eng J Med 1996;335:462−7.
16. Huang L, Xu AM. Adenocarcinoma of esophagogastric junction: controversial classification, surgical management, and clinicopathology, Chin J Cancer 2014;26:226−30.
17. Bonenkamp JJ, Hermans J, Sasako M, et al. Extended lyphm-node dissection for gastric cancer. N Engl J Med 1999;340:908−14.
18. Cuschieri A. Weeden S, Fielding J, et al. Patient survival after D1 and D2 resections for gastric cancer: long-term results of the MRC randomized surgical trial. Surgical Co-operative Group. Br J Cancer 1999;79:1522−30.
19. Tepper J, Krasna MJ, Niedzwiecki D, et al. Phase III trial of trimodality therapy with cisplatin, florouracil, radiotherapy, and surgery compared with surgery alone for esophagel cancer: CALGB 9781. J Clin Oncol 2008;26:236−44.
20. Jung do H, Ahn SH, Park do J, et al. Proximal gastrectomy for gastric cancer. J Gastric Cancer 2015;15:77−86.
21. Nai C, Liu Z, Lian X, et al. [Survival rate of proximal and total gastrectomy in treatment of esophagogastric junction adenocarcinoma (SiewertII( Types)] [Chinese] Zhonghua Wei Chang Wai Ke Za Zhi 2016;19:195−9.
22. Harwick RH, Williams GT. Staging of esophageal adenocarcinoma. Br J Surg 2002;89:1076−77.
Štítky
Surgery Orthopaedics Trauma surgeryČlánok vyšiel v časopise
Perspectives in Surgery
2016 Číslo 12
- Metamizole at a Glance and in Practice – Effective Non-Opioid Analgesic for All Ages
- Metamizole vs. Tramadol in Postoperative Analgesia
- Spasmolytic Effect of Metamizole
Najčítanejšie v tomto čísle
- Rare case of a giant parathyroid adenoma
- 10 years of sleeve gastrectomy in the Czech Republic in terms of the surgical procedure
- Purtscher-like retinopathy as a complication of acute pancreatitis
- Proximal gastrectomy for adenocarcinoma of the gastroesophageal junction in a selected set of patients − immediate and long-term results