Surgical Treatment of Adenocarcinomas of the Gastroesophageal Junction

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Abstract
Based on a prospective study of 151 operated adenocarcinomas of the gastroesophageal junction, the subdivision into adenocarcinomas of Barrett’s esophagus (type I), actual cardia carcinomas (type II) and subcardial adenocarcinomas (type III) appears meaningful to us. Preoperative matching can be achieved by means of radiography and endoscopy with a high degree of reliability. This classification allows the determination of an adeguate extent of resection. For type I a transmediastinal subtotal esophagectomy and proximal gastrectomy is performed; the reconstruction is done by gastric interposition with cervical anastomosis. For type II (tumor stages 1 and 2) and type III we use an abdominal and right thoracic approach for total gastrectomy and distal esophageal resection and reconstruction with Roux-en-Y esophago-jejunoplication. The most radical procedure of transmediastinal subtotal esophagectomy and total gastrectomy with reconstruction by colon interposition is preserved for advanced tumor stages (3 and 4) of type II carcinomas. The operation rate of the total series of 189 adenocarcinomas of the gastroesophageal junction was 80%, the resection rate 99.3%. The 30-day mortality of all operated cases was 5.2% (type 18.3%, II5.2%, III 3.1 %). All 3 tumor types had a similar distribution of cancer stages (stage 1+2: 37%, stage 3+4: 63%). The estimated 4 year survival probability showed a trend for more favourable results of the patients with type I carcinoma (type I 47%, II 24%, III 32%).

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