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1 . 2022

Modified classification and tactics in radical surgical treatment for gastroesophageal junction cancer: results of single-center trial of 100 operations

Abstract

The choice of treatment for adenocarcinoma of the gastroesophageal junction (GEJ) is based not only on staging but also on the topographical classification. In spite of wide spread of the disease, there is no universal strategy for its treatment. The aim of this study is to standardize the surgical approach according to Siewert type and tumor spreading by using the modified classification for GEJ cancer.

Material and methods. We studied the immediate and long-term results of treatment of 100 patients with GEJ adenocarcinoma who underwent the surgery from June 2011 to July 2016. We used the modified classification of GEJ cancer which included Siewert type, tumor spreading (Japanese classification of esophageal and gastric carcinomas 2010) and stage (TNM-7). There were 13 (13%) patients with Siewert I type, 33 (33%) with Siewert II type and 54 (54%) with Siewert III type. There were 14% patients with stage I, 13% with stage III, 67% with stage III, 6% with stage IV according to tumor spreading.

Results. There were 89% radical resections (R0) and 11% R1 resections. Postoperative morbidity due to complications was 37%, 12% patients had to be treated in ICU. General complications rates were 1.5 times higher than the specific ones (20 versus 10%), in 7% were combination thereof. Esophageal anastomosis failure developed in 8 (8%) patients: esohagojejunoanastomosis in 7 patients, cervical esophagogastroanastomosis in 1 patient. The hospital mortality rate was 3%. Tumor progression was detected in 42 (43.3%) patients: distant metastasis in 21 (21.7%), loco-regional reccurence in 14 (14.4%), local reccurence in 7 (7.2%) patients. Long-term survival in the periods of 1–2–3–4–5 years were 88.8, 72.8, 62.5, 55.8 and 55.8% respectively. The best survival rate was in patients with Siewert II tumors (5-year survival – 59.9%).

Conclusion. The use of a standardized strategy combined with an individual selection of a type of the surgical approach for GEJ tumors with different spreading allows to achieve a high radical cancer treatment, surgical safety and efficiency without increasing of postoperative morbidity and mortality rates.

Keywords:adenocarcinoma of the gastroesophageal junction (GEJ); esophagectomy; gastrectomy; proximal gastrectomy; distal gastrectomy; esophagogastrectomy, Siewert type

Funding. The study had no sponsor support.
Conflict of interest. The authors declare no conflict of interest.
For citation: Ruchkin D.V., Nazariev P.I., Okonskaya D.E., Kozlov V.A., Savelieva V.A. Modified classification and tactics in radical surgical treatment for GEJ cancer: results of single-center trial of 100 operations. Clinical and Experimental Surgery. Petrovsky Journal. 2022; 10 (1): 10–9. DOI: https://doi.org/10.33029/2308-1198-2022-10-1-10-19  (in Russian)

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CHIEF EDITOR
CHIEF EDITOR
Sergey L. Dzemeshkevich
MD, Professor (Moscow, Russia)

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