Surgical treatment of Siewert type II gastroesophageal junction cancer: esophagectomy, total gastrectomy or other options?

Objective To analyze the effect of neoadjuvant radiotherapy (nRT) on prognosis in patients with locoregional Siewert type II gastroesophageal junction adenocarcinoma (GEA). Method All patients pathologically diagnosed as Siewert type II GEA between 2004 and 2015 were retrieved from the Surveillance, Epidemiology and Final Results (SEER) database. We analyzed the impact of different treatment regimens on the prognosis in each stage. Survival analysis was performed by Kaplan-Meier (K-M) method. Multivariate Cox model and propensity score matching was further used to verify the results. Results 4,160 patients were included in this study. The efficacy of nRT was superior to that of adjuvant radiotherapy (aRT) (p = 0.048), which was the same as that of surgery combined with chemotherapy (p = 0.836), but inferior to the overall survival (OS) of surgical treatment alone (p<0.001) in T1-2N0M0 patients. Patients receiving nRT had distinctly better survival than those receiving surgical treatment alone (p = 0.008), but had similar survival compared with patients treated with aRT (p = 0.989) or surgery combined with chemotherapy (p = 0.205) in the T3N0/T1-3N+M0 subgroup. The efficacy of nRT is clearly stronger than that of surgical therapy alone (p<0.001), surgery combined with chemotherapy (p<0.001), and aRT (p = 0.008) in patients with T4 stage. The survival analysis results were consistent before and after propensity score matching. Conclusion In these carefully selected patients, the present study made the following recommendations: nRT can improve the prognosis of patients with T3N0M0/T1-3N+M0 and T4 Siewert type II GEA, and it seems to be a better treatment for T4 patients. Surgery alone seems to be sufficient, and nRT is not conducive to prolonging the survival of Siewert II GEA patients with T1-2N0M0 stage. Of course, further prospective trials are needed to verify this conclusion.

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Proximal Gastrectomy versus Total Gastrectomy for Siewert Type II Adenocarcinoma of the Esophagogastric Junction: A Comprehensive Analysis of Data from the SEER Registry

Disease Markers ◽

10.1155/2019/9637972 ◽

2019 ◽

Vol 2019 ◽

pp. 1-11 ◽

Cited By ~ 2

Author(s):

Kaixuan Zhu ◽

Yingying Xu ◽

Jiaxin Fu ◽

Farah Abdidahir Mohamud ◽

Zongkui Duan ◽

...

Keyword(s):

Total Gastrectomy ◽

Surgical Approach ◽

Esophagogastric Junction ◽

Proximal Gastrectomy ◽

Locally Advanced ◽

Cox Proportional Hazards Model ◽

Type Ii ◽

Siewert Type ◽

Siewert Type Ii ◽

Significant Difference

Background. To determine the ideal surgical approach (total gastrectomy (TG) vs. proximal gastrectomy (PG)) for Siewert type II adenocarcinoma of the esophagogastric junction (AEG), we searched and analyzed the Surveillance, Epidemiology, and End Results (SEER) data. Methods. Patients with Siewert type II AEG treated by TG or PG were identified from the 2004–2014 SEER dataset. We obtained the patients’ overall survival (OS) and cancer-specific survival (CSS) and stratified the patients by surgical approach. We performed a propensity score 1 : 1 matching (PSM) analysis and a univariate and multivariate Cox proportional hazards model. Results. A total of 2,217 patients with 6th AJCC stage IA–IIIB Siewert type II AEG was examined: 1,584 patients (71.4%) underwent PG, and 633 patients (28.6%) underwent TG. The follow-up time was 1–131 months. OS favored total gastrectomy before the PSM analysis (χ2=3.952, p=0.047), but after this analysis, there was no significant difference between TG and PG (χ2=2.227, p=0.136). The univariate and multivariate analyses identified age as an independent factor, and an X-tail analysis revealed 70 years as a cut-off point. The patients aged≥70 years obtained a significant long-term OS benefit from PG compared to TG (χ2=8.245, p=0.004), and those aged<70 years showed no difference between TG and PG (χ2=0.167, p=0.682). Conclusions. PG showed an equivalent survival benefit to TG in both the early and locally advanced stages of Siewert type II AEG. For elderly patients, PG is strongly recommended because of its clearer OS benefit compared to TG.

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Clinicopathologic Comparison of Siewert Type II and III Adenocarcinomas of the Gastroesophageal Junction

World Journal of Surgery ◽

10.1007/s00268-005-0434-x ◽

2006 ◽

Vol 30 (3) ◽

pp. 364-371 ◽

Cited By ~ 28

Author(s):

Norihiro Yuasa ◽

Hideo Miyake ◽

Tatsuharu Yamada ◽

Tomoki Ebata ◽

Yuji Nimura ◽

...

Keyword(s):

Gastroesophageal Junction ◽

Type Ii ◽

Siewert Type ◽

Siewert Type Ii

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Novel abdominal approach for dissection of advanced type II/III adenocarcinoma of the esophagogastric junction: a new surgical option

Journal of International Medical Research ◽

10.1177/0300060518802923 ◽

2018 ◽

Vol 47 (1) ◽

pp. 398-410 ◽

Cited By ~ 2

Author(s):

Can Hu ◽

Hao-te Zhu ◽

Zhi-yuan Xu ◽

Jian-fa Yu ◽

Yi-an Du ◽

...

Keyword(s):

Lymph Node ◽

Survival Rate ◽

Postoperative Complications ◽

Total Gastrectomy ◽

Surgical Approach ◽

Esophagogastric Junction ◽

Abdominal Cavity ◽

Type Ii ◽

Siewert Type ◽

Siewert Type Ii

Objective The optimal surgical approach for Siewert type II adenocarcinoma of the esophagogastric junction (AEG) is controversial. In this study, we evaluated the outcomes of total gastrectomy for Siewert type II/III AEG via the left thoracic surgical approach that is used at our center. Methods We identified 41 patients with advanced AEG in our retrospective database and analyzed their 3-year survival rate, upper surgical margin, postoperative complications, and index of estimated benefit from lymph node dissection. Results The 3-year overall survival rate of the whole group was 63%, but no difference was observed between Siewert type II and III AEGs. Esophageal exposure and lymphadenectomy were sufficient. Eight patients developed postoperative complications, but none of the patients developed anastomotic leakage. Dissection of lymph node station Nos. 19 and 110 may be necessary for patients with Siewert type II AEG. Multivariate analysis revealed that the cT category was the only independent risk factor. Conclusions Total gastrectomy via an approach from the abdominal cavity into the thoracic cavity may be an optimal surgical technique for advanced Siewert type II AEG.

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FA01.06: ON THE RELATIONSHIP BETWEEN HISTOLOGY, ESOPHAGEAL-GASTRIC INTESTINAL METAPLASIA, GREATER CURVATURE LYMPHATIC METASTASES AND SURVIVAL IN SIEWERT II ADENOCARCINOMA

Diseases of the Esophagus ◽

10.1093/dote/doy089.fa01.06 ◽

2018 ◽

Vol 31 (Supplement_1) ◽

pp. 2-3

Author(s):

Marialuisa Lugaresi ◽

Benedetta Mattioli ◽

Valentina Tassi ◽

Niccolò Daddi ◽

Alberto Ruffato ◽

...

Keyword(s):

Intestinal Metaplasia ◽

Total Gastrectomy ◽

Intestinal Type ◽

Type Ii ◽

Diffuse Type ◽

Cancer Specific Survival ◽

Siewert Type ◽

Siewert Type Ii ◽

Greater Curvature ◽

The Relationship

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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