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SURGICAL OUTCOME OF ESOPHAGOGASTRIC JUNCTIONAL CANCER: DATA FROM A TERTIARY REFERRAL CENTER IN HONG KONG
Claudia Wong*, Daniel King Hung Tong, Kwan Kit Chan, Ian Yu Hong Wong, Siu Y. Chan, Tsz Ting Law, Simon Law
The University of Hong Kong, Hong Kong, Hong Kong
Introduction: There are many controversies on the classification, staging system and treatment strategy for adenocarcinoma of the esophagogastric junction (EGJ). Amidst westernization of lifestyle, EGJ cancer is gaining interest in Asia. There is not much data from the East on this disease entity.
Method: From 2003 to 2013, patients diagnosed to have adenocarcinoma of EGJ and who underwent surgical resection were studied. Patient demographics and surgical outcomes including post-operative morbidity and survival were compared. Patients were grouped based on the Siewert classification system and the survival of each type was compared.
Results: EGJ cancers were diagnosed in 123 patients. The median age was 71 yrs (ranged 40-91) and 100 of them were males (81.3%). Among these patients, 108 (87.8%) underwent. Curative (R0) resection was achieved in 89 patients (82.4%). Types I, II and III tumors were diagnosed in 12, 63 and 14 patients respectively. Demographic data of subgroups were comparable. Median follow-up time was 22 months (1-154 months). The choice of resection was determined by the location and extent of tumor (Table 1). Nine patients had surgical complications including anastomotic leak n=5 (5.6%), gastric conduit ischemia n=1 (1.1%), chylothorax n=1 (1.1%) and vocal cord palsy n=2 (1 transient, 1 permanent, 2.2%). There was no post-operative mortality. Overall median survival was 43 months (3-year survival = 78.9%). The overall survival of types I to III patients were 71, 43 and 21 months respectively.
Conclusion: There is an overall trend of poorer survival in type III EGJ cancers after curative (R0) resection.
Table 1. Surgical Approach for Esophagogastric Junctional Cancers
| | Siewert type | | Surgical approach | I | II | III | | Videothoracoscopic esophagogastrectomy | 1 | 2 | 0 | | Lewis-Tanner/Videothoracoscopic esophagogastrectomy | 9 | 44 | 4 | | Proximal gastrectomy | 2 | 13 | 2 | | Total gastrectomy | 0 | 4 | 8 |
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