The pattern of recurrence of adenocarcinoma of the oesophago-gastric junction

Abstract

Knowledge of the pattern of recurrence of surgically treated cases of adenocarcinoma of the oesophago-gastric junction is important both for better understanding of their biological nature and for future strategic planning of therapy. The aim of this study is to demonstrate and compare the pattern of dissemination and recurrence in patients with Type I and Type II adenocarcinoma of oesophago-gastric junction. A prospective audit of the clinico-pathological features of patients who had undergone surgery with curative intent for adenocarcinoma of oesophago-gastric junction between 1991 and 1996 was undertaken. Patients were followed up by regular clinical examination. Clinical evaluation was supported by ultrasound, computerised tomography, radio-isotope bone scan, endoscopy and laparotomy each with biopsy and histology where appropriate. One hundred and sixty-nine patients with oesophago-gastric junction tumours (94 Type I and 75 Type II) have been followed up for a median of 75.3 (57 -133) months. One hundred and three patients developed proven recurrent disease. The median time to recurrence was 23.3 (14.2 -32.4) months for Type I and 20.5 (11.6 -29.4) for Type II cancers. The most frequent type of recurrence was haematogenous (56% of Type I recurrences and 54% of Type II) of which 56% were detected within 1 year of surgery. The most frequent sites were to liver (27%), bone (18%) brain (11%) and lung (11%). Local recurrence occurred in 33% of Type I cancer and 29% of Type II recurrences. Nodal recurrence occurred in 18 and 25% of Type I and Type II cancer recurrences, most frequently to coeliac or porta hepatis nodes (64%). Only 7% of Type I and 15% of Type II cancer recurrences were by peritoneal dissemination. Type I and Type II adenocarcinoma of the oesophago-gastric junction have a predominantly early, haematogenous pattern of recurrence. There is a need to better identify the group of patients with small metastases at the time of diagnosis who are destined to develop recurrent disease in order that they may be spared surgery and those with micro metastases in order that they can be offered multi-modality therapy including early post operative or neo-adjuvant chemotherapy.

Pattern of abdominal nodal spread and optimal abdominal lymphadenectomy for advanced Siewert type II adenocarcinoma of the cardia: results of a multicenter study

“…In our series, 48 patients died of relapsed disease, involving nodal recurrence in 29 patients (4 cervical, 7 mediastinal, 20 para-aortic), hematogenous (liver, lung, bone, adrenals, brain, skin) recurrence in 23 patients, peritoneal dissemination in 7 patients, and local relapse in 4 patients. Both para-aortic lymph node metastasis and hematogenous metastasis were the predominant mode of recurrence, with peritoneal dissemination being less frequent; this was consistent with previous reports [19,24].…”

A phase II trial of preoperative chemotherapy with epirubicin, cisplatin and capecitabine for patients with localised gastro-oesophageal junctional adenocarcinoma

“…In this study, there was a trend towards improved survival for patients achieving an R0 compared with an R1 resection, which did not reach statistical significance and is likely to reflect the small patient numbers. The majority of patients relapsing after resection presented with distant metastases, consistent with earlier observations in oesophageal and GOJ adenocarcinoma (Wayman et al, 2002), and highlighting the need for surgical adjuncts incorporating effective systemically directed therapies in this disease. Preoperative approaches remain the most extensively investigated with only a limited number of small negative randomised trials assessing adjuvant therapy mainly in squamous carcinoma (Malthaner et al, 2004).…”

Lymph node metastases and prognosis in oesophageal carcinoma – A systematic review

“…Nodal micrometastases have been shown to correlate with lymphatic infiltration [70], tumour size [71],vascular invasion [67] and risk of lymph node recurrence [56]. However, there is no evidence as yet that correlates these occult deposits to the location or timing of …”