[Clinical and pathological prognostic factors for cancers of the esophagogastric junction]. / Klinisch-pathologische Prognosefaktoren des Adenokarzinoms des gastroösophagealen Ubergangs.

INTRODUCTION: Adenocarcinoma of the esophagogastric junction (AEG) is a particular tumour entity because two substantially different surgical procedures are required according to the location. There is no difference in long-term prognosis between the tumour types in spite of the different surgical procedures. We were interested to evaluate the clinical and pathological prognostic factors of the AEGs which were operated in our department. PATIENTS AND METHODS: 108 patients were operated for AEG between 1.1.2000 and 1.4.2006 in our institution. 32 (29.6 %) patients with distal esophageal cancer (type I according to Siewert) underwent a transthoracic esophagectomy with gastric pull-up and two-field lymphadenectomy. 57 (52.8 %) patients with type II and 19 (17.6 %) patients with type III cancers received an extended gastrectomy with D2 lymphadenectomy. The retrospective analysis was focused on clinical and pathological parameters. Possible differences between the tumour types were also evaluated. Median follow-up was 11.4 months (range: 1-57 months). RESULTS: Follow-up data were complete for 107 patients. A median survival of 17.4 +/- 3.25 months and a cumulative survival of 30 % were independent of the tumour location and the surgical procedure. Overall hospital mortality was 3.7 %. The univariate analysis showed that survival was significantly associated with the T category, lymph node status, lymphangio- and angioinvasion and tumour grading. In the multivariate analysis, only lymph node status was identified as an independent prognosis factor for survival. Where-as the R status was not a prognostic factor per se, how-ever, patients with an R0 situation without lymphangio- and angioinvasion had a significantly better survival compared to all other patients (p = 0.001). An increased angioinvasion rate was observed in type III tumours (52.6 %) in comparison to type I (21.9 %) and type II (21.1 %) tumours. CONCLUSION: The prognostic factors of our patients determined substantially the prognosis of the patients. Patients with lymph- or haemangioinvasion should regarded as high-risk patients independent of the R status. Close oncological follow-up including potential adjuvant treatment in these patients is recommended.

Surgical results of patients after esophageal resection or extended gastrectomy for cancer of the esophagogastric junction.

Precise classification of cancers of the esophagogastric junction according to Siewert may be difficult for the presence of Barrett's esophagus or hiatal hernia, which subsequently leads to a difficult choice of the surgical procedure of esophagectomy or gastrectomy. Ninety-six patients with such cancers were operated on in our department in 7 years. Twenty-nine patients (30.2%), classified as type I (group 1), underwent a transthoracic esophagectomy with gastric pull up. Sixty-seven patients (69.8%) classified as type II or III (group 2) underwent an extended gastrectomy. We compared the patients of both groups retrospectively for disease-free survival and postoperative complications. The general performance status of most patients was comparable in both groups and was assigned to the American Society of Anesthesiologists class II or III. Statistically significant differences between the groups were seen for the postoperative reintubation rate [group 1: 31.0% vs. group 2: 9.0% (P = 0.009)], median time for surgery [group 1: 6 (3.5-8.5) hours vs. group 2: 4.7 (2.2-11.5) hours (P = 0.001)], time in the intensive care unit [group 1: 6 (3-85) days vs. group 2: 3 (1-54) days (P = 0.001)], median hospitalization time [group 1: 23 (14-105) days vs. group 2: 18 (10-63) days (P = 0.018)]. No statistical difference was observed for the recurrence-free survival of 40% after 3 years (P = 0.311), the mortality rate, the morbidity rate (P = 0.108), surgical and respiratory complications, and the incidence of anastomotic leakage (P = 0.645). We conclude that in selected cases it may be possible to perform an extended gastrectomy for small type I cancers.

[Impact of the body mass index on the prognosis and complication rate after surgical resection of cancers at the oesophagogastric junction]. / Einfluss des Body-Mass-Index auf die Prognose und Komplikationsrate nach Resektion beim Kardiakarzinom.

BACKGROUND: An elevated body mass index (BMI) is associated with an increased incidence of cancer at the gastro-oesophageal junction. Less is known about the postoperative complication rate and prognosis in relation to the BMI. PATIENTS AND METHODS: We investigated 108 patients with cancer of the cardia and a BMI below (group 1, n = 56) or above (group 2, n = 52) 25 kg / m (2), who were operated from 2000 to 2006 in our department. According to the Siewert classification, the tumours were subdivided into 3 types. Patients with type I cancers (n = 26) received a transthoracic oesophageal resection with gastric pull up. Patients with type II (n = 61) or type III (n = 21) cancers underwent an extended gastrectomy. The complication rates and survival were analysed. RESULTS: The complications were pulmonary (respiratory insufficiency n = 12, pneumonia n = 12, bronchitis n = 7, pulmonary embolism n = 2), surgical (anastomotic leakage n = 7, abscesses n = 8, bleeding n = 2, chylus fistula n = 1), or functional (dysphagia n = 5, nausea n = 5, heart burn n = 4, delayed enteral passage n = 6, vomiting n = 9). Patients of group 2 showed more delayed enteral passages (5 vs. 1) and more vomiting (7 vs. 2) than those of group 1. The median stay in the intensive care unit was shorter in group 1 than in group 2 (3 vs. 5 days) (p = 0.021). Overall hospitalisation was 14 days in the mean in both groups. We found no significant difference in the postoperative mortality of 6.5 % (n = 7) between the two groups. Overall survival after a follow-up of 42 months was 34 % (group 1) and 25 % (group 2). The difference did not reach statistical significance (p = 0.961). Patients with an elevated BMI show slightly more complications than those with a lower BMI. CONCLUSIONS: Our data show that patients with elevated BMI have slightly more complications and an identical long term survival as patients with normal body weight.