Abstract
Background
In Siewert type II adenocarcinoma we investigated the relationship between adenocarcinoma subtypes and survival, histologic/biologic patterns related to the presence/absence of gastric greater curvature metastases.
Methods
154 patients who underwent primary transthoracic esophageal resection, total gastrectomy, thoracic-abdominal lymphadenectomy according to a research prospective protocol were considered. Cases were categorized in intestinal and diffuse subtypes, in Barrett's-like, cardiopyloric-like, and gastric-like adenocarcinoma according to the presence/absence of intestinal metaplasia in esophagus and stomach. Cancer specific survival and gastric greater curvature metastases were studied in those categories.
Results
Pathological stage (7th TNM ed) was IA-IIA in 11%; IIB in 15.6%; IIIA-IV in 73.4%. Cases were: 59% intestinal-type, 41% diffuse-type; Barrett's-type 1.3%, cardiopyloric-type 65%, gastric-type 33.7%. Greater gastric curvature lymph node metastases were detected in 22%, in stage IIIa-IV only, intestinal type 47%; diffuse type 53%. The number of metastatic lymph nodes at station 4 was higher in cardiopyloric-like than in gastric-like type (P < .0001).Five years cancer-specific survival of 154 cases was 40.5%, 59.4.% for intestinal type, 0% for diffuse type; 5-year cancer-specific survival in the absence/presence of greater gastric curvature metastases was respectively 48.7% and 14.9%, for intestinal type it was 67.4% and 27.9%. Histological subtype was an independent prognostic factor.
Conclusion
The radical difference of 5 year survival between intestinal and diffuse types of Siewert type II adenocarcinoma after primary surgery, the relevant frequency and biologic patterns of station 4 nodal metastases do require further investigation in light of current indications for neoadjuvant therapy and total gastrectomy.
Disclosure
All authors have declared no conflicts of interest.
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