Staging and outcome depending on surgical treatment in adenocarcinomas of the oesophagogastric junction
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Staging and outcome depending on surgical treatment in adenocarcinomas of the oesophagogastric junction. / Reeh, M; Mina, S; Bockhorn, M; Kutup, A; Nentwich, M F; Marx, A; Sauter, G; Rösch, T; Izbicki, J R; Bogoevski, D.
in: BRIT J SURG, Jahrgang 99, Nr. 10, 01.10.2012, S. 1406-14.Publikationen: SCORING: Beitrag in Fachzeitschrift/Zeitung › SCORING: Zeitschriftenaufsatz › Forschung › Begutachtung
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TY - JOUR
T1 - Staging and outcome depending on surgical treatment in adenocarcinomas of the oesophagogastric junction
AU - Reeh, M
AU - Mina, S
AU - Bockhorn, M
AU - Kutup, A
AU - Nentwich, M F
AU - Marx, A
AU - Sauter, G
AU - Rösch, T
AU - Izbicki, J R
AU - Bogoevski, D
N1 - Copyright © 2012 British Journal of Surgery Society Ltd. Published by John Wiley & Sons, Ltd.
PY - 2012/10/1
Y1 - 2012/10/1
N2 - BACKGROUND: Owing to controversial staging and classification of adenocarcinoma of the oesophago-gastric junction (AOG) before surgery, the choice of appropriate surgical approach remains problematic. In a retrospective study, preoperative staging of AOG and the impact of preoperative misclassification on outcome were analysed.METHODS: Data from patients with AOG were analysed from a prospectively collected database with regard to surgical treatment, preoperative and postoperative staging, and outcome.RESULTS: One-hundred and thirty patients with Siewert types I and II AOG who did not have neoadjuvant treatment were included in the study: 41 patients with an AOG type I who underwent oesophagectomy, 51 patients with an AOG staged before surgery as type I who underwent oesophagectomy but in whom the final histology showed a type II tumour, and 38 patients whose tumours were staged as AOG type II before and after operation who underwent gastrectomy. Among patients who had an oesophagectomy, lymph node metastases (P = 0.022), tumour relapse (P = 0.009) and recurrent distant metastases (P = 0.028) were significantly more frequent in patients with AOG type II; those with AOG type II had shorter overall survival than those with type I tumours (P = 0.024). Among those with AOG type II, recurrence-free survival was significantly shorter after oesophagectomy compared with extended gastrectomy (P = 0.019). Thoracoabdominal oesophagectomy had a favourable influence on outcome compared with the transhiatal approach.CONCLUSION: Accurate preoperative staging of AOG and appropriate surgical therapy are crucial for outcome. AOG type II is a more aggressive tumour with higher recurrence rates than AOG type I. These patients therefore benefit from more radical surgical treatment.
AB - BACKGROUND: Owing to controversial staging and classification of adenocarcinoma of the oesophago-gastric junction (AOG) before surgery, the choice of appropriate surgical approach remains problematic. In a retrospective study, preoperative staging of AOG and the impact of preoperative misclassification on outcome were analysed.METHODS: Data from patients with AOG were analysed from a prospectively collected database with regard to surgical treatment, preoperative and postoperative staging, and outcome.RESULTS: One-hundred and thirty patients with Siewert types I and II AOG who did not have neoadjuvant treatment were included in the study: 41 patients with an AOG type I who underwent oesophagectomy, 51 patients with an AOG staged before surgery as type I who underwent oesophagectomy but in whom the final histology showed a type II tumour, and 38 patients whose tumours were staged as AOG type II before and after operation who underwent gastrectomy. Among patients who had an oesophagectomy, lymph node metastases (P = 0.022), tumour relapse (P = 0.009) and recurrent distant metastases (P = 0.028) were significantly more frequent in patients with AOG type II; those with AOG type II had shorter overall survival than those with type I tumours (P = 0.024). Among those with AOG type II, recurrence-free survival was significantly shorter after oesophagectomy compared with extended gastrectomy (P = 0.019). Thoracoabdominal oesophagectomy had a favourable influence on outcome compared with the transhiatal approach.CONCLUSION: Accurate preoperative staging of AOG and appropriate surgical therapy are crucial for outcome. AOG type II is a more aggressive tumour with higher recurrence rates than AOG type I. These patients therefore benefit from more radical surgical treatment.
KW - Adenocarcinoma
KW - Adult
KW - Aged
KW - Esophageal Neoplasms
KW - Esophagectomy
KW - Esophagogastric Junction
KW - Female
KW - Gastrectomy
KW - Humans
KW - Intraoperative Care
KW - Kaplan-Meier Estimate
KW - Lymphatic Metastasis
KW - Male
KW - Middle Aged
KW - Neoplasm Staging
KW - Preoperative Care
KW - Retrospective Studies
KW - Stomach Neoplasms
U2 - 10.1002/bjs.8884
DO - 10.1002/bjs.8884
M3 - SCORING: Journal article
C2 - 22961520
VL - 99
SP - 1406
EP - 1414
JO - BRIT J SURG
JF - BRIT J SURG
SN - 0007-1323
IS - 10
ER -
