ABSTRACT
This study was performed to analyze the surgical results of 66 patients with adenocarcinoma of the esophagogastric AEG Junction subjected to curative resection. Between Sep. 2000 and Sep 2003, 66 patients with AEG including 20 type I, 16 type II and 30 type Ill were subjected to surgical resection in NCI Cairo University, South Egypt Cancer Institute [SECI] Assiut University, Nasser institute and Aswan Cancer Center. Patients with type I tumors [distal esophagus] underwent total esophagogastric transhiatal transthoracic or through three fields approach [abdominal, thoracic and cervical] or .subtotal esophagectomy with thoracic reconstruction. Patients with type Ill [gastric cardia] anderwent total or proximal gastrectomy with either transhiatal or transthoracic reconstruction For type II tumors [true cardia], total esophagectomy, subtotal esophagectomy, proximal gastrectomy with distal esophagectomy or total gastrectomy with distal esophagectomy were done with transhiatal, transthoracic or three field approach. Pathology, TNM stage, surgical approach, morbidity, mortality and survival were studied among the 3 groups. There were 54 male patients and 12 females with a median age 53 teams twenty patients [30.3%] had type I tumors, 16 [24.2%] had type II tumors and 30 [45.5%] had type Ill tumors twenty seven [41%] [20 type is 7 type II] underwent total esophagectomy or subtotal distal through transhiatal, trans thoracic or abdominal, thoracic and cervical approach Thirty nine patients [59%]. including thirty patients with type III and 7 patients with type II underwent gastrectomy 27 [41%] total and 12 [18%] proximal gastrectomy. Postoperative mortality was 9% and morbidity was 228.7% Overall survival [OS] was 88% at 12 months and 44.6% at 24 months while disease free survival [DFS] was 69.4% and 20.7% respectively. Lymph nodes [+ve vs-ve] and stage [I+II vs Ill+IV] grade percent of ve abdominal lymph nodes and total abdominal and mediastinal lymph nodes had prognostic significance while type of tumour, surgical approach, type of R resection, surgical margin size of the tumour and mediastinal lymph nodes were non significant on univariate analysis. while the abdominal lymph nodes were the only significant variable on multivariate analysis. Adenocarcinoma of the cardia is associated with poor survival. Early diagnosis remains the prerequisite for curative treatment. The classification of AEG into type I, II and III provides a useful tool for selecting the surgical approach