Diagnosis and Treatment of 52 Patients with Adenocarcinoma of the Esophagogastric Junction / 中国医科大学学报

ABSTRACT

Objective Performing special studies in patients with adenocarcinomas of the esophagogastric junction (AEG) can provide an effective clinical basis for diagnosis and successful treatment.Methods We retrospectively analyzed and summarized the diagnosis,operative procedure,and postoperative complications in 52 cases of AEG in patients who underwent surgical treatment at the First Hospital of China Medical University between June 2011 and May 2016.Results In addition to carcinoembryonic antigen (CEA),carbohydrate antigen 19-9 (CA19-9) is a useful tumor marker with a positively higher rate of preoperative detection of AEG.With respect to choice of surgical approach,type Ⅰ tumors were treated using transthoracic en bloc esophagectomy with resection of the proximal stomach,while type Ⅱ and Ⅲ tumors were primarily treated with an extended total gastrectomy with transhiatal resection of the distal esophagus.We observed in our study that stage Ⅲ tumors were the most common type,and intra-pulmonary infection was the commonest postoperative complication.Conclusion AEG continues to remain one of the most difficult clinical problems.Middle-aged and elderly patients presenting with persistent epigastric and postprandial discomfort require special attention.Adopting a rational surgical strategy is the basis of achieving radical cure.We propose that patients with type Ⅱ tumors should be treated with a radical total gastrectomy,and a distal esophagectomy through the esophageal hiatus,if necessary,should be combined with a thoracic approach to ensure radical surgery.