Terapia adjuvante associada à esofagectomia melhora a sobrevida nos pacientes portadores de adenocarcinoma da junção esofagogástrica?

Tercioti-Júnior, Valdir; Lopes, Luiz Roberto; Sallum, Rubens Antônio Aissar; Andreollo, Nelson Adami; Malafaia, Osvaldo

doi:10.1590/s0102-67202013000200001

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“…The study in our Service 27 , including 103 patients with adenocarcinoma of the esophagogastric junction, comparing 78 submitted to surgical treatment with 25 submitted to the operation followed by chemoradiation, using the protocol of Macdonald et al, showed no increase in survival at five years of follow-up.…”

Section: Discussion Discussion Discussion Discussion Discussionmentioning

confidence: 80%

“…Factors associated with higher cancer recurrence risks include tumor differentiation, advanced stage, lymph node invasion and involvement of surgical margins. Treatment of local recurrence is extremely complex, with greater difficulty in the posterior mediastinal transposition [26][27][28] . The recurrence recorded in the patients described here was restricted to stages III and IV, attesting to the greater relevance of tumor aggressiveness.…”

Section: Discussion Discussion Discussion Discussion Discussionmentioning

confidence: 99%

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Total esophagogastrectomy in the neoplasms of the esophagus and esofagogastric junction: when must be indicated?

Andreollo

Neto

Calomeni

et al. 2015

Rev. Col. Bras. Cir.

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Objective: to analyse the indications and results of the total esophagogastrectomy in cancers of the distal esophagus and esophagogastric junction. Methods: twenty patients with adenocarcinomas were operated with a mean age of 55 ± 9.9 years (31-70 years), and 14 cases were male (60%). Indications were 18 tumors of the distal esophagus and esophagogastric junction (90%) and two with invasion of gastric fundus (10%) in patients with previous gastrectomy. Preoperative colonoscopy to exclude colonic diseases was performed in ten cases. Results: the surgical technique consisted of median laparotomy and left cervicotomy, followed by transhiatal esophagectomy associated with D2 lymphadenectomy. The reconstructions were performed with eight esophagocoloduodenoplasty and the others were Roux-en-Y esophagocolojejunoplasty to prevent the alkaline reflux. Three cases were stage I / II, while 15 cases (85%) were stages III / IV, reflecting late diagnosis of these tumors. The operative mortality was 5 patients (25%): a mediastinitis secondary to necrosis of the transposed colon, abdominal cellulitis secondary to wound infection, severe pneumonia, an irreversible shock and sepsis associated with colojejunal fistula. Four patients died in the first year after surgery: 3 (15%) were due to tumor recurrence and 1 (5%) secondary to bronchopneumonia. The 5-year survival was 15%. Conclusion: the total esophagogastrectomy associated with esophagocoloplasty has high morbidity and mortality, requiring precise indication, and properly selected patients benefit from the surgery, with the risk-benefit acceptable, contributing to increased survival and improved quality of life

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Section: Discussion Discussion Discussion Discussion Discussionmentioning

confidence: 80%

Section: Discussion Discussion Discussion Discussion Discussionmentioning

confidence: 99%