Pattern of recurrence after surgery in adenocarcinoma of the gastro-oesophageal junction

Manzoni, Giovanni De; Pedrazzani, Corrado; Pasini, Felice; Durante, E; Gabbani, Milena; Grandinetti, A.; Guglielmi, Alfredo; Griso, C.; Cordiano, Claudio

doi:10.1016/s0748-7983(03)00098-2

Cited by 60 publications

(41 citation statements)

References 22 publications

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“…Type I tumor, or adenocarcinoma of the lower esophagus often associated with Barrett's esophagus, according to Siewert's classification (7) was reported to be the most prevalent type in the European institutions (8,9). However, Type III subcardial carcinoma was by far the most common type in Japan (10) as well as in the current study.…”

Section: Discussionsupporting

confidence: 46%

Issues in the Management of the Upper Third Gastric Cancer

Yang

2004

Cancer Res Treat

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Purpose: The choice of surgical strategy for patients with adenocarcinoma of the upper one third of the stomach is controversial. This study was performed to analyze the surgical results of a 11-year experience with these lesions.Materials and Methods: From January 1990 to December 2000, 259 patients with upper third gastric cancer underwent proximal gastrectomy (n=74) or total gastrectomy (n=185) through an abdominal approach. Morbidity, mortality, recurrence patterns, and survival were compared between these two groups retrospectively.Results: There were no significant differences in general complication and mortality rates between the two groups. However, the incidences of reflux esophagitis (16.2% ) and anastomotic stricture (35.1% ) were more common in the proximal gastrectomy group compared with the total gastrectomy group (0.5 and 8.1%). Regarding the main patterns of recurrence, local recurrence was dominant in the proximal gastrectomy group, whereas distant recurrence was dominant in the total gastrectomy group. Five-year overall survival (54.8 versus 47.8% ) and survival according to tumor stage were no different between the groups. Multivariate analysis showed that the extent of resection was not an independent prognostic factor.Conclusion: The extent of resection for upper third gastric cancer did not appear to affect long-term outcome. However, proximal gastrectomy is associated with an increased risk of reflux esophagitis, anastomotic stricture, and local recurrence.

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Section: Discussionsupporting

confidence: 46%

Issues in the Management of the Upper Third Gastric Cancer

Yang

2004

Cancer Res Treat

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“…6,7 When EAC recurs, the anatomic location of recurrence tends to be distant more often than in ESCC. 8,9 Whereas EAC incidence has dramatically increased since 1975 in the United States, ESCC incidence has dropped by half over the same time period. 10 This is one of the largest reported single-institution cohort studies [11][12][13] to describe long-term cancer outcomes for EAC in which patients underwent complete resection of all tumor mostly without perioperative chemotherapy or radiotherapy.…”

confidence: 99%

The Prognostic Value of Clinical and Pathologic Factors in Esophageal Adenocarcinoma: A Mayo Cohort of 796 Patients With Extended Follow-up After Surgical Resection

Yoon

Khan

Cassivi

et al. 2010

Mayo Clinic Proceedings

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OBJECTIVE: To identify and describe clinicopathologic prognostic factors in patients with esophageal adenocarcinoma who underwent surgical resection with curative intent. PATIENTS AND METHODS:The study cohort consisted of 796 patients with adenocarcinoma of the esophagus, gastroesophageal junction, or gastric cardia who underwent complete tumor resection at Mayo Clinic from January 1, 1980, to December 31, 1997. We reviewed individual patient medical records and abstracted demographic, pathologic, perioperative, and cancer outcome data. Median follow-up for vital status and disease recurrence was 12.8 and 5.8 years, respectively. RESULTS:Univariate analysis revealed the following factors to be statistically associated with worse 5-year disease-specific survival: higher N and T status, higher tumor grade, age older than 76 years, and the presence of extracapsular lymph node extension and signet ring cells. The following factors remained significantly linked with worse 5-year disease-specific survival on multivariate analysis: higher N and T status, grade, and age and the absence of preoperative chemotherapy or radiotherapy. Anatomic location of tumor was not associated with differential prognosis. Lymph node metastases were found in 25 (27%) of 93 T1b tumors, 397 (85%) of 468 T3 tumors, and 22 (67%) of 33 T4a tumors. Diseasespecific survival was better in T3-4N0 than in T1bN1-3 carcinomas (hazard ratio, 0.50; 95% confidence interval, 0.28-0.89, adjusted for grade and age; P=.02). CONCLUSION:Our results confirm the importance of T and N status and tumor grade and suggest that age may affect prognosis. In addition, we show that a significant proportion of superficial esophageal adenocarcinomas exhibit regional metastases and have worse prognosis than more invasive nonmetastatic tumors. Proc. 2010;85(12):1080-1089 AIC = Akaike information criterion; AJCC = American Joint Committee on Cancer; CI = confidence interval; DFS = disease-free survival; DSS = disease-specific survival; EAC = esophageal adenocarcinoma; ESCC = esophageal squamous cell carcinoma; GEJ = gastroesophageal junction; HR = hazard ratio; LN = lymph node; OS = overall survival Mayo Clin © 2010 Mayo Foundation for Medical Education and ResearchT he increase in the incidence of adenocarcinoma of the esophagus, gastroesophageal junction (GEJ), and gastric cardia in recent decades has been among the highest for any cancer in Western countries. 1 This triad of adenocarcinomas (designated esophageal adenocarcinoma [EAC] in this article) has grown more than 400% in incidence in the past 40 years, paralleling the increase in obesity and gastroesophageal reflux. 2 It is lethal in most cases, yet its degree of aggressiveness also varies from person to person. 3 These statistics signal a need for a better understanding of not only EAC etiology, but its progression and long-term clinical behavior. Understanding and exploiting the heterogeneity in prognosis are critical to improving outcomes in EAC patients and require the study of large cohorts with well-descri...

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“…Surgical resection remains the most important element of a potentially curative treatment. Although the addition of neoadjuvant therapy has shown to improve postoperative survival rates [4,5], the risk of local or distant tumor recurrence remains substantial [6,7,8]. …”

Section: Introductionmentioning

confidence: 99%

Patient Preferences in Screening for Recurrent Disease after Potentially Curative Esophagectomy

Blom¹,

Nieuwkerk

Heijl³

et al. 2012

Dig Surg

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Background: Routine imaging (RI) as part of follow-up after potentially curative esophagectomy is currently not widely accepted. If detected recurrent disease could be adequately treated, it remains unclear whether patients would want to take part in a screening program. The aim of this study was to determine the extent to which patients who underwent esophagectomy prefer follow-up with or without RI. Methods: Patients who underwent esophagectomy for carcinoma without evidence of recurrent disease were included. An interview-administered questionnaire was used to assess fear of recurrence and elicit patient preferences for the frequency and duration of follow-up and hypothetical changes of survival chances (1–10%). Results: 45/54 eligible patients (83%) participated in this study. The majority of patients preferred follow-up with RI (67%) even if screening would not provide a survival benefit; this proportion increased up to 93% if the proposed chances of survival improved. Younger patients and patients with a lower histopathological tumor stage were more likely to desire follow-up with RI. Conclusion: Most patients who underwent esophagectomy preferred RI as part of follow-up over outpatient clinic visits only, even if such screening would not provide a survival benefit. Further research is needed to determine the most accurate screening modality and most efficient follow-up interval.

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Pattern of recurrence after surgery in adenocarcinoma of the gastro-oesophageal junction

Cited by 60 publications

References 22 publications

Issues in the Management of the Upper Third Gastric Cancer

Issues in the Management of the Upper Third Gastric Cancer

The Prognostic Value of Clinical and Pathologic Factors in Esophageal Adenocarcinoma: A Mayo Cohort of 796 Patients With Extended Follow-up After Surgical Resection

Patient Preferences in Screening for Recurrent Disease after Potentially Curative Esophagectomy

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