1 / 40

Carcinoma of the Cardia: Is there progress in the management of non-Barrett’s cancer

Carcinoma of the Cardia: Is there progress in the management of non-Barrett’s cancer. XXIV Congress. Spanish Association of Surgeons Madrid 11 November 2002. The University of Hong Kong. Adenocarcinoma of Esophagogastric Junction. Reflux esophagitis is rare in Asia

stanislaw-aurek
Download Presentation

Carcinoma of the Cardia: Is there progress in the management of non-Barrett’s cancer

An Image/Link below is provided (as is) to download presentation Download Policy: Content on the Website is provided to you AS IS for your information and personal use and may not be sold / licensed / shared on other websites without getting consent from its author. Content is provided to you AS IS for your information and personal use only. Download presentation by click this link. While downloading, if for some reason you are not able to download a presentation, the publisher may have deleted the file from their server. During download, if you can't get a presentation, the file might be deleted by the publisher.

E N D

Presentation Transcript

  1. Carcinoma of the Cardia: Is there progress in the management of non-Barrett’s cancer XXIV Congress Spanish Association of Surgeons Madrid 11 November 2002 The University of Hong Kong

  2. Adenocarcinoma of Esophagogastric Junction • Reflux esophagitis is rare in Asia • Barrett’s esophagus and cancer are clinical curiosities • One Chinese patient out of 1,200 resections had Barrett’s cancer • Adenocarcinoma of cardia and proximal stomach is a continuum

  3. Adenocarcinoma of Esophagogastric Junction • Presentation is late, with anaemia followed by dysphagia • Resection is mostly palliative • CT or CTRT is undergoing trials • Survival has not increased significantly over the last two decades

  4. Olmsted County 1974-1989 Cases / 100,000 / yr Squamous Adeno (GEJ) Adeno (ESO) Pera et al, Gastroenterology, 1993

  5. Surgical Resection

  6. Fein et al, Surgery, 1998

  7. Fein et al, Surgery, 1998

  8. Controversy Does type II behave as type I (esophageal) or type III (gastric) ?

  9. Adenocarcinoma of Esophagogastric Junction Adenocarcinoma of the distal esophagus and gastric cardia are one clinical entity Wijnhoven et al, BJS, 1999

  10. No. at risk Total 252 175 100 62 42 25 Oesophagus 111 76 43 25 18 12 Gastric cardia 141 99 57 37 24 13 Wijnhoven et al, BJS, 1999

  11. Adenocarcinoma of Esophagogastric Junction Tumors spreads to thoracic and abdominal lymph nodes Staging as esophageal or gastric cancers makes no different in survival Suggested that these tumors behaves like esophageal cancer Steup et al, J Thorac Cardiovasc Surg, 1996

  12. Adenocarcinoma of the Esophagogastric Junction Type II cancers can be treated by abdominal gastrectomy Siewert et al, Ann Surg, 2000

  13. Adenocarcinoma of Esophagogastric Junction Limited Resection for Carcinoma of Cardia 1970 – 1988; 149 patients Ellis et al, Ann Surg, 1988

  14. Adenocarcinoma of Esophagogastric Junction Proximal gastrectomy should be performed for upper third gastric cancer when invasion is confined to muscularis propria Kitamura et al, Surg Today, 1997

  15. Adenocarcinoma of Esophagogastric Junction Total gastrectomy is not necessary for proximal gastric cancer Harrison et al, Surgery, 1998

  16. Adenocarcinoma of Esophagogastric Junction After resection of proximal gastric cancer, use of gastric tube is the best reconstruction Shiraishi et al, WJS, 2002

  17. Adenocarcinoma of Esophagogastric Junction An operation based on “epi-centre” of tumor is appropriate and can be performed safely and with acceptable survival Fein et al, Surgery, 1998

  18. Esophageal Cancer

  19. Adenocarcinoma of Esophagogastric Junction

  20. Adenocarcinoma of Esophagogastric Junction Main Treatment (%)

  21. Adenocarcinoma of Esophagogastric Junction Main Treatment (%)

  22. Adenocarcinoma of Esophagogastric Junction Overall Resection 70% CT / RT 8% Intubation 2% No treatment 11%

  23. Adenocarcinoma of Esophagogastric Junction Site of Anastomosis (%)

  24. Adenocarcinoma of Esophagogastric Junction Resection Margin and Anastomotic Site

  25. Adenocarcinoma of Esophagogastric Junction Resection Margin and Recurrence

  26. Adenocarcinoma of Esophagogastric Junction Complications (%)

  27. Survival After Resection ADC N=223

  28. Survival After Resection SCC N=855

  29. Adenocarcinoma of Esophagogastric Junction Mortality (%)

  30. Adenocarcinoma of Esophagogastric Junction Mortality and Morbidity (%) Major complications No differences

  31. Survival after Resection ADC (N = 223) p = 0.4838

  32. Adenocarcinoma of Esophagogastric Junction Survival – ADC 223 Resections

  33. Survival after Resection ADC (N = 223) p < 0.01

  34. Survival after Resection ADC (N = 223) p = 0.2850

  35. Evolution of Treatment & Outcome 1970-2001 Patients 1097 Curative resection 994 Survivors 879 1970-1985 246 (Group 1) 1986-1996 465 (Group 2) 1997-2001 283 (Group 3) 1997-2001 230 (HKU) Hofstetter et al, Ann Surg, 2002

  36. Evolution of Treatment & Outcome Group 1 Group 2 Group 3 HKU M / F 2/1 4/1 8/1 5/1 ADC / SCC (%) 29/71 66/32 83/17 27/73 M1/3 / L1/3 (%) 34/44 19/74 13/86 44/19 Hofstetter et al, Ann Surg, 2002

  37. Evolution of Treatment & Outcome Group 1 Group 2 Group 3 HKU Transhiatal (%) 7 29 33 0.4 Gastric conduit (%) 64 97 99 94 Neoadjuvant CT (%) 2 33 5 5 RT (%) 51 3 1 0 CTRT (%) 2 10 59 27 Hofstetter et al, Ann Surg, 2002

  38. Evolution of Treatment & Outcome Group 1 Group 2 Group 3 HKU Hospital mortality (%) 12 5 6 0 Leakage (%) 10 10 6 4 R0 resection (%) 78 87 94 72 Recurrence (%) 43 49 33 57 Survival Median (m) 13 21 32 20 3 yr (%) 27 34 46 33 Hofstetter et al, Ann Surg, 2002

  39. Survival after Resection University of Texas n=1097 University of Hong Kong n=1094 p < 0.01

  40. Conclusions • Carcinoma of cardia presents late • Complications of operations are less than SCC • Mortality can be reduced to zero • Thoracotomy does not add risks • Prognosis same in SCC & ADC • Systemic CT or CTRT may have benefit • Regional CT may be superior • Prediction of response important to determine

More Related