Adenocarcinoma of the oesophagogastric junction Siewert II: An oesophageal cancer better cured with total gastrectomy

Abstract Neoadjuvant chemoradiotherapy according to the Dutch randomised controlled ChemoRadiotherapy for Oesophageal cancer followed by Surgery Study (CROSS) has become standard of care for patients with cancer of the oesophagus or oesophagogastric junction. The aim of this study was to provide more insight into the ultra-long-term impact of CROSS neoadjuvant chemoradiotherapy on survival and disease recurrence for patients with oesophageal cancer. Methods Patients with locally advanced resectable squamous cell carcinoma or adenocarcinoma of the oesophagus or oesophagogastric junction were randomised between neoadjuvant chemoradiotherapy (five weekly cycles of intravenous carboplatin [AUC 2 mg/mL per min] and intravenous paclitaxel [50 mg/m2 of body-surface area]) with concurrent 41.4 Gy radiotherapy given in 23 fractions of 1.8 Gy, 5 days per week) plus surgery (nCRT arm) versus surgery alone (surgery arm). Primary endpoint was overall survival, defined from date of randomisation to date of all-cause death or to last day of follow-up. Secondary endpoints were cause-specific mortality and conditional survival. Analysis was by intention-to-treat. Results From 2004 through 2008, 178 patients were randomized to the nCRT arm and 188 to the surgery arm. Median follow-up for surviving patients was 146.6 months (IQR 133.5–157.2). Ten-year overall survival was 38% in the nCRT arm and 25% in the surgery arm (HR 0.68 [95%CI 0.53–0.87]). For patients with squamous cell carcinoma ten-year overall survival was 46% in the nCRT arm compared to 23% in the surgery arm. For patients with adenocarcinoma ten-year overall survival was 36% in the nCRT arm and 26% in the surgery arm. In the nCRT arm, ten-year oesophageal cancer-specific mortality was 47%. Conclusion Survival benefit of patients with locally advanced resectable squamous cell carcinoma or adenocarcinoma of the oesophagus or oesophagogastric junction receiving neoadjuvant chemoradiotherapy persists for at least 10 years compared to patients undergoing surgery alone.

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A prospective study on the role of neoadjuvant chemoradiotherapy on surgical outcome in resectable oesophageal carcinoma

International Journal of Research in Medical Sciences ◽

10.18203/2320-6012.ijrms20214819 ◽

2021 ◽

Author(s):

Hrishikesh Deka ◽

Bhabesh Kumar Das ◽

Rajiv Paul ◽

Supriyo Majumdar

Keyword(s):

Oesophageal Cancer ◽

Clinical Stage ◽

Locally Advanced ◽

Neoadjuvant Chemoradiotherapy ◽

Oesophageal Carcinoma ◽

Tumor Burden ◽

R0 Resection ◽

Oesophagogastric Junction ◽

A Prospective Study

Background: Initial results of the chemo-radiotherapy for oesophageal cancer followed by surgery study (CROSS) comparing neoadjuvant chemoradiotherapy (NACRT) plus surgery versus surgery alone in patients with squamous cell carcinoma and adenocarcinoma of the oesophagus or oesophagogastric junction showed a significant increase in 5-year overall survival in favour of the NACRT plus surgery group after a median of 45 months' follow-up. In this study we will interpret the short-term results of NACRT on resectable, locally advanced oesophageal carcinoma.Methods: Patients with clinically resectable, locally advanced cancer of the oesophagus or oesophagogastric junction (clinical stage T1N1M0 or T2-3N0-1M0, according to the AJCC, 8th edition) were assigned to receive weekly administration of four cycles of NACRT (intravenous carboplatin [AUC 2 mg/mL per min] and intravenous paclitaxel [50 mg/m 2 of body-surface area] for 23 days) with concurrent radiotherapy (41·4 Gy, given in 23 fractions of 1·8 Gy on 5 days per week) followed by McKeown’s oesophagectomy from 01 January, 2020 to 31 May, 2021.Results: It was observed in our study that 38.46% patients had achieved a CPR after the administration of NACRT as per the CROSS-trial protocol which is comparable to PCR achieved in CROSS trial (29%). All the patients underwent an R0 resection during surgery (100%) which is comparable to CROSS trial (92%).12Conclusions: In our study which had collected data over a period of 17 months we learnt that the administration of NACRT in locally advanced oesophageal cancer was effective in reducing the tumor burden and achieving a satisfactory CPR of 38.46%.

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Successful curative surgery for postoperative oesophageal recurrence of oesophagogastric junction cancer

BMJ Case Reports ◽

10.1136/bcr-2020-234829 ◽

2020 ◽

Vol 13 (7) ◽

pp. e234829

Author(s):

Masahiko Ikebe ◽

Nobuhide Kubo ◽

Seiichi Fukuyama ◽

Tokujiro Yano

Keyword(s):

Ct Scan ◽

Total Gastrectomy ◽

Locoregional Recurrence ◽

Lower Lobe ◽

Curative Surgery ◽

Diagnosis And Prognosis ◽

Oesophagogastric Junction ◽

Lower Oesophagus ◽

Thoracoabdominal Incision ◽

Tumour Reduction

A man in his 70s had undergone total gastrectomy for oesophagogastric junction cancer. Three years and 11 months later, he began to vomit after meals and was diagnosed with mediastinal recurrence of oesophagogastric junction cancer. A CT scan showed that the tumour was suspected of infiltrating the aorta and lung. He received two cycles of chemotherapy with S-1 plus cisplatin, resulting in tumour reduction. The patient underwent resection of the lower oesophagus, including the tumour, the left lower lobe of the lung and the pericardium through a left thoracoabdominal incision. This is the first report of a patient surgically resected for postoperative oesophageal recurrence of oesophagogastric junction cancer. Although most postoperative recurrences of oesophagogastric junction cancer are far advanced at the time of diagnosis and prognosis is poor, chemotherapy followed by surgery may improve the prognosis of patients with locoregional recurrence.

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A commentary on “Ten-year follow-up results of a randomized clinical trial comparing left thoracoabdominal and abdominal transhiatal approaches to total gastrectomy for adenocarcinoma of the oesophagogastric junction or gastric cardia”

Translational Gastroenterology and Hepatology ◽

10.21037/tgh.2016.03.08 ◽

2016 ◽

Vol 1 ◽

pp. 12-12 ◽

Cited By ~ 2

Author(s):

Shinji Mine ◽

Masayuki Watanabe

Keyword(s):

Clinical Trial ◽

Randomized Clinical Trial ◽

Total Gastrectomy ◽

Gastric Cardia ◽

Oesophagogastric Junction

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Palliative oesophagogastrectomy for dysphagia due to adenocarcinoma at the esophagogastric junction

Bangladesh Journal of Otorhinolaryngology ◽

10.3329/bjo.v17i2.8859 ◽

1970 ◽

Vol 17 (2) ◽

pp. 150-153

Author(s):

Md Abdul Mobin Choudhury ◽

Md Abdul Alim Shaikh

Keyword(s):

Photodynamic Therapy ◽

Laser Ablation ◽

Key Words ◽

Surgical Resection ◽

Oesophageal Cancer ◽

Esophagogastric Junction ◽

Advanced Disease ◽

Oesophageal Adenocarcinoma ◽

Bipolar Coagulation ◽

Oesophagogastric Junction

Dysphagia is the usual presenting feature of oesophageal cancer & is generally a sign of advanced disease. Palliation in this disease demands relief of dysphagia. Palliation of dysphagia can be achieved in a number of ways which includes surgical resection, stenting, laser ablation, photodynamic therapy, ethanol necrosis & bipolar coagulation. We report here a case of dysphagia due to lower oesophageal adenocarcinoma treated by palliative oesophagogestrectomy. Key words: Dysphagia; Adenocarcinoma at oesophagogastric junction; Palliative oesophagogestrectomy. DOI: http://dx.doi.org/10.3329/bjo.v17i2.8859 BJO 2011; 17(2): 150-153

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Pernicious Anemia Following Total Gastrectomy for Giant Hypertrophy of the Gastric Rugae (Menetrier’s Disease)

Gastroenterology ◽

10.1016/s0016-5085(19)35271-0 ◽

1960 ◽

Vol 39 (3) ◽

pp. 347-350 ◽

Cited By ~ 2

Author(s):

Earl E. Gambill ◽

Donald C. Campbell ◽

Donald C. Balfour ◽

John M. Waugh ◽

Malcolm B. Dockerty

Keyword(s):

Pernicious Anemia ◽

Total Gastrectomy ◽

Menetrier’S Disease ◽

Ménétrier's Disease ◽

Menetrier's Disease

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18F-Deoxyglucose PET for the staging of oesophageal cancer

Nuklearmedizin ◽

10.1055/s-0038-1625303 ◽

2003 ◽

Vol 42 (03) ◽

pp. 90-93 ◽

Cited By ~ 9

Author(s):

N. Döbert ◽

O. Rieker ◽

W. Kneist ◽

St. Mose ◽

A. Teising ◽

...

Keyword(s):

Oesophageal Cancer ◽

Squamous Cell ◽

Distal Part ◽

Standard Uptake Value ◽

Squamous Cell Carcinomas ◽

Tumour Grading ◽

Positron Emission ◽

Group A ◽

The Mean ◽

Drop Outs

SummaryAim: Evaluation of the influence of histopathologic sub-types and grading of primaries of oesophageal cancer, relative to their size and location, on the uptake of 18F-deoxyglucose (FDG) as measured by positron emission tomography (PET). Methods: 50 consecutive patients were evaluated. There were four drop-outs due to previous surgical and/or chemotherapeutical treatments and thus in 46 patients (28 squamous cell carcinomas and 18 adenocarcinomas) a pretherapeutic PET evalution of the primary including a standard uptake value (SUV) was obtained. In 42 cases data on tumour grading were available also. Results: Squamous cell carcinomas (SCC) were in 7/13/8 cases located in the proximal, medial and distal part of the oesophagus, respectively the grading was Gx in 3, G 2 in 12, G2-3 in 7, and G3 in 6 cases. The SUVmax showed a mean of 6.5 ± 2.8 (range 1.7-13.5). Adenocarcinomas (ACA) were located in the medial oesophagus in two cases and otherwise in its distal parts. Grading was Gx in one, G2 in 4, G2-3 in 3, G3 in 3, G3-4 in 3, and G4 in one case. The mean SUVmax was 5.2 ± 3.2 (range 1-13.6) and this was not significantly different from the SCC. Concerning the tumour grading there was a slight, statistically not relevant trend towards higher SUVmax in more dedifferentiated cancer. Discussion: SCC and ACA of the oesophagus show no relevant differences in the FDG-uptake. While there was a significant variability of tumour uptake in the overall study group, a correlation of SUV and tumour grading was not found.

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