Outcome of surgical treatment for early adenocarcinoma of the esophagus or gastro-esophageal junction

• Published in: Virchows Archiv : an international journal of pathology Vol. 446; no. 5; pp. 497 - 504
• Main Authors: WESTERTERP, Marinke, KOPPERT, Linetta B, BUSKENS, Christianne J, TILANUS, Hugo W, TEN KATE, Fiebo J. W, BERGMAN, Jacques J. H. G. M, SIERSEMA, Peter D, VAN DEKKEN, Herman, VAN LANSCHOT, Jan J. B
• Format: Journal Article
• Language: English
• Published: Berlin Springer 01.05.2005; Springer Nature B.V
• Subjects: Adenocarcinoma - mortality; Adenocarcinoma - pathology; Adenocarcinoma - surgery; Adult; Aged; Aged, 80 and over; Barrett Esophagus - pathology; Biological and medical sciences; Cancer; Chemotherapy; Esophageal Neoplasms - mortality; Esophageal Neoplasms - pathology; Esophageal Neoplasms - surgery; Esophagogastric Junction; Esophagus; Female; Gastroenterology. Liver. Pancreas. Abdomen; Humans; Investigative techniques, diagnostic techniques (general aspects); Lesions; Lymphatic Metastasis; Male; Medical sciences; Middle Aged; Multivariate analysis; Neoplasm Invasiveness; Neoplasm Recurrence, Local; Neoplasm Staging; Other diseases. Semiology; Pathology. Cytology. Biochemistry. Spectrometry. Miscellaneous investigative techniques; Prognosis; Regression Analysis; Surgery; Treatment Outcome; Tumors; Stomach; Prognosis; Digestive system; Esophageal disease; Early stage; Barrett esophagus; Malignant tumor; Survival; GEJ; Early cancer; Anatomic pathology; Surgery; Barrett's esophagus; Digestive diseases; Evolution; Early; Esophagus adenocarcinoma; Junction; Substage
• ISSN: 0945-6317; 1432-2307
• DOI: 10.1007/s00428-005-1243-1

Adenocarcinoma of the esophagus, or GEJ, has a poor prognosis. Early lesions [i.e. high grade dysplasia (HGD) or T1-carcinoma] are potentially curable. Local endoscopic therapies are promising treatment options for superficial lesions; however, for deeper lesions, surgical resection is considered to be the treatment of choice. To contribute to therapeutic decision-making, we retrospectively analysed the outcome of transhiatal esophagectomy in 120 patients with pathologically proven HGD (n=13) or T1-adenocarcinoma (n=107) of the distal esophagus or gastro-esophageal junction (GEJ). Tumors were subdivided into six different depths of invasion ('T1-mucosal' m1-m3, 'T1-submucosal' sm1-sm3), and the frequency of lymphatic dissemination and time to locoregional and/or distant recurrence were analysed. Only one of the 79 T1m1-3/sm1 tumors (1%) showed lymph node metastases as compared with 18 out of 41 T1sm2-3 tumors (44%). There was a significant difference in recurrence-free period between T1m1-m3/sm1 versus T1sm2-sm3 tumor patients (P log rank <0.0001), with 5-year recurrence-free percentages of 97% and 57%, respectively. In multivariate analysis including age, gender, tumor differentiation grade, N-stage and depth of invasion, only N-stage was an independent prognostic factor for recurrence-free period (hazard rate=5.9, 95% CI 1.7-20.7). However, if N-stage was excluded from analysis, only depth of invasion (T1sm2-3 versus T1m1-m3/sm1) was an independent prognostic factor for recurrence-free period (hazard rate=7.5, 95% CI 2.0-27.7). These data indicate that T1m1-m3/sm1 adenocarcinomas of esophagus or GEJ show a very low risk of lymphatic dissemination and are therefore eligible for local endoscopic therapy. After transhiatal surgical resection, almost half of the patients with T1sm2-sm3 lesions develop recurrent disease within 5 years, and therefore need additional therapy to improve survival.