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2007 Program and Abstracts | 2007 Posters
Limited Resection of the Distal Esophagus and the Cardia for Early Adenocarcinoma of the Junction: Preliminary Survival Data
Paulus G. Schurr*, Jussuf T. Kaifi, Mette Bornbusch, Phillip Busch, Helge Kleinhans, Dean Bogoevski, Tim Strate, Oliver Mann, Emre F. Yekebas, Jakob Izbicki
Department of General, Visceral and Thoracic Surgery, University Medical Center Hamburg, Hamburg, Germany

Background: Esophageal resections for early distal cancer may be performed as limited resections with jejunal interposition. For long, subtotal resection and cervical gastric pull-up has been the mainstay of reconstruction.
Patients and Methods: Between 2000 and 2004, 18 patients underwent limited resection of the distal esophagus and the cardia for early adenocarcinoma and were compared to 72 patients with subtotal esophagectomy.
Results: Subtotal and limited esophageal resections are depicted in the table. 10/72 subtotal and 2/18 limited resections displayed pN1 status (13.9 and 11.1%, respectively, p=1.00, Fisher's exact test) and the mean nodal surgical retrieval was 25 and 15 lymph nodes, respectively. At a median observation time of 38.9 and 31.1 months, 33/72 and 16/18 patients survived, respectively (p=0.050, Kaplan-Meier model, log-rank test). 9/72 subtotal esophagectomies were followed by anastomotic postoperative leak, whereas leak was not observed in the other group (chi-square p= 0.11). Perioperative deaths occurred exclusively in the subtotal esophagectomy group (4/72, 5.7%).
Conclusions: Limited resection is a less traumatizing alternative and might be equally effective in terms of local tumor control in patients with early cancer without nodal metastases.

P=0.030* Resections: subtotal limited Total No.
Histopathology:
Carcinoma only in endoscopical biopsy No. (%) 7 (9.7%) 5 (27.8%) 12 (13.3%)
HGIEN No. (%) 1 (1.4%) 2 (11.1%) 3 (3.3%)
pT1a No. (%) 17 (23.6%) 3 (16.7%) 75 (22.2%)
pT1b No. (%) 47 (65.3%) 8 (44.4%) 55 (61.1%)
Total No. No. (%) 72 (100%) 18 (100%) 90 (100%)

Table: Histopathology and surgeries: HGIEN=high grade intraepithelial neoplasia. *chi-square test


2007 Program and Abstracts | 2007 Posters
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