Skip to main content
NCBI home page
Annals of Surgery logoLink to Annals of Surgery
. 1989 Oct;210(4):535–543. doi: 10.1097/00000658-198910000-00014

The results of esophagogastrectomy without thoracotomy for adenocarcinoma of the esophagogastric junction.

R J Finley 1, R I Inculet 1
PMCID: PMC1357940  PMID: 2478086

Abstract

Between 1980 and 1988, 98 patients with adenocarcinoma of the esophagogastric junction were seen at the University of Western Ontario. Eighty-two patients underwent resection of the celiac lymph nodes, lesser curve and cardia of the stomach, and thoracic esophagus through abdominal and neck incisions avoiding thoracotomy. The esophagus was replaced by a stomach tube in 80 patients or by a colon tube in two patients. Two of 82 patients died while hospitalized. Early postoperative morbidity included anastomotic leaks that closed spontaneously (13), transient hoarseness (10), myocardial infarction (2), pulmonary embolus (6), and atelectasis or pneumonia (13). Late postoperative complications included delayed gastric emptying (4), symptomatic reflux (4), diarrhea (10), and anastomotic strictures (17). The 2-year survival of 30% was significantly affected by the stage of disease (p = 0.003), depth of tumor penetration (p = 0.02), lymph node metastasis (p = 0.001), tumor differentiation (p = 0.008), and tumor DNA ploidy (p = 0.02). Local recurrences appeared initially in 20 patients: anastomotic (3), peritoneal (14), mediastinal (3); distant metastasis occurred in 27 patients: bone (15), liver (5), brain (2), and multiple organs (5). Swallowing was restored and maintained in 75 patients. Esophagogastrectomy without thoracotomy provides a safe, effective method of restoring swallowing in patients with adenocarcinoma of the esophagogastric junction. This technique provides acceptable survival and local recurrence rates.

Full text

PDF
535

Selected References

These references are in PubMed. This may not be the complete list of references from this article.

  1. Barbier P. A., Luder P. J., Schüpfer G., Becker C. D., Wagner H. E. Quality of life and patterns of recurrence following transhiatal esophagectomy for cancer: results of a prospective follow-up in 50 patients. World J Surg. 1988 Apr;12(2):270–276. doi: 10.1007/BF01658073. [DOI] [PubMed] [Google Scholar]
  2. Castrini G., Pappalardo G. Carcinoma of the cardia: tactical problem. J Thorac Cardiovasc Surg. 1981 Aug;82(2):190–193. [PubMed] [Google Scholar]
  3. Coia L. R., Paul A. R., Engstrom P. F. Combined radiation and chemotherapy as primary management of adenocarcinoma of the esophagus and gastroesophageal junction. Cancer. 1988 Feb 15;61(4):643–649. doi: 10.1002/1097-0142(19880215)61:4<643::aid-cncr2820610404>3.0.co;2-4. [DOI] [PubMed] [Google Scholar]
  4. DeMeester T. R., Zaninotto G., Johansson K. E. Selective therapeutic approach to cancer of the lower esophagus and cardia. J Thorac Cardiovasc Surg. 1988 Jan;95(1):42–54. [PubMed] [Google Scholar]
  5. Ellis F. H., Jr, Gibb S. P., Watkins E., Jr Limited esophagogastrectomy for carcinoma of the cardia. Indications, technique, and results. Ann Surg. 1988 Sep;208(3):354–361. doi: 10.1097/00000658-198809000-00013. [DOI] [PMC free article] [PubMed] [Google Scholar]
  6. Finley R. J., Grace M., Duff J. H. Esophagogastrectomy without thoracotomy for carcinoma of the cardia and lower part of the esophagus. Surg Gynecol Obstet. 1985 Jan;160(1):49–56. [PubMed] [Google Scholar]
  7. Gunderson L. L., Sosin H. Adenocarcinoma of the stomach: areas of failure in a re-operation series (second or symptomatic look) clinicopathologic correlation and implications for adjuvant therapy. Int J Radiat Oncol Biol Phys. 1982 Jan;8(1):1–11. doi: 10.1016/0360-3016(82)90377-7. [DOI] [PubMed] [Google Scholar]
  8. Hilgenberg A. D., Carey R. W., Wilkins E. W., Jr, Choi N. C., Mathisen D. J., Grillo H. C. Preoperative chemotherapy, surgical resection, and selective postoperative therapy for squamous cell carcinoma of the esophagus. Ann Thorac Surg. 1988 Apr;45(4):357–363. doi: 10.1016/s0003-4975(98)90004-2. [DOI] [PubMed] [Google Scholar]
  9. Koga S., Hamazoe R., Maeta M., Shimizu N., Murakami A., Wakatsuki T. Prophylactic therapy for peritoneal recurrence of gastric cancer by continuous hyperthermic peritoneal perfusion with mitomycin C. Cancer. 1988 Jan 15;61(2):232–237. doi: 10.1002/1097-0142(19880115)61:2<232::aid-cncr2820610205>3.0.co;2-u. [DOI] [PubMed] [Google Scholar]
  10. MacFarlane S. D., Hill L. D., Jolly P. C., Kozarek R. A., Anderson R. P. Improved results of surgical treatment for esophageal and gastroesophageal junction carcinomas after preoperative combined chemotherapy and radiation. J Thorac Cardiovasc Surg. 1988 Mar;95(3):415–422. [PubMed] [Google Scholar]
  11. Molina J. E., Lawton B. R., Myers W. O., Humphrey E. W. Esophagogastrectomy for adenocarcinoma of the cardia. Ten years' experience and current approach. Ann Surg. 1982 Feb;195(2):146–151. doi: 10.1097/00000658-198202000-00004. [DOI] [PMC free article] [PubMed] [Google Scholar]
  12. Moreaux J., Msika S. Carcinoma of the gastric cardia: surgical management and long-term survival. World J Surg. 1988 Apr;12(2):229–235. doi: 10.1007/BF01658061. [DOI] [PubMed] [Google Scholar]
  13. Paolini A., Tosato F., Cassese M., De Marchi C., Grande M., Paoletti P., Gherardini P., Fegiz G. Total gastrectomy in the treatment of adenocarcinoma of the cardia. Review of the results in 73 resected patients. Am J Surg. 1986 Feb;151(2):238–243. doi: 10.1016/0002-9610(86)90077-2. [DOI] [PubMed] [Google Scholar]
  14. Papachristou D. N., Fortner J. G. Adenocarcinoma of the gastric cardia. The choice of gastrectomy. Ann Surg. 1980 Jul;192(1):58–64. doi: 10.1097/00000658-198007000-00010. [DOI] [PMC free article] [PubMed] [Google Scholar]
  15. Postlethwait R. W. Complications and deaths after operations for esophageal carcinoma. J Thorac Cardiovasc Surg. 1983 Jun;85(6):827–831. [PubMed] [Google Scholar]
  16. Skinner D. B., Little A. G., Ferguson M. K., Soriano A., Staszak V. M. Selection of operation for esophageal cancer based on staging. Ann Surg. 1986 Oct;204(4):391–401. doi: 10.1097/00000658-198610000-00007. [DOI] [PMC free article] [PubMed] [Google Scholar]
  17. Viste A., Haùgstvedt T., Eide G. E., Søreide O. Postoperative complications and mortality after surgery for gastric cancer. Ann Surg. 1988 Jan;207(1):7–13. doi: 10.1097/00000658-198801000-00003. [DOI] [PMC free article] [PubMed] [Google Scholar]
  18. Wang P., Chien K. Surgical treatment of carcinoma of the esophagus and cardia among the Chinese. Ann Thorac Surg. 1983 Feb;35(2):143–151. doi: 10.1016/s0003-4975(10)61450-6. [DOI] [PubMed] [Google Scholar]

Articles from Annals of Surgery are provided here courtesy of Lippincott, Williams, and Wilkins

RESOURCES