Z Gastroenterol 2017; 55(08): e57-e299
DOI: 10.1055/s-0037-1604779
Kurzvorträge
Ösophagus und Magen
Operationsstrategien beim Ösophagus- und Magenkarzinom: Freitag, 15 September 2017, 13:10 – 14:30, Florenz/Forschungsforum 3
Georg Thieme Verlag KG Stuttgart · New York

Adenocarcinoma of the esophagogastric junction Siewert Type II: gastrectomy versus esophagectomy

T Glatz
1   Universitätsklinikum Freiburg, Allgemein- und Viszeralchirurgie, Freiburg, Deutschland
,
J Höppner
1   Universitätsklinikum Freiburg, Allgemein- und Viszeralchirurgie, Freiburg, Deutschland
,
S Fichtner-Feigl
1   Universitätsklinikum Freiburg, Allgemein- und Viszeralchirurgie, Freiburg, Deutschland
,
T Keck
2   Universitätsklinikum Schleswig-Holstein, Campus Lübeck, Klinik für Chirurgie, Lübeck, Deutschland
,
E Petrova
2   Universitätsklinikum Schleswig-Holstein, Campus Lübeck, Klinik für Chirurgie, Lübeck, Deutschland
,
R Hummel
2   Universitätsklinikum Schleswig-Holstein, Campus Lübeck, Klinik für Chirurgie, Lübeck, Deutschland
› Author Affiliations
Further Information

Publication History

Publication Date:
02 August 2017 (online)

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Introduction:

There is an increasing incidence of adenocarcinoma of the esophagogastric junction within recent years. Surgery remains a corner stone of treatment and depends on tumor location. German National Guidelines recommend extended gastrectomy for Siewert Type II tumors. However, in some cases the extent of tumor mandates esophagectomy. The aim of this study was to compare outcome after gastrectomy and esophagectomy within 25 years at two German University Hospitals.

Methods:

We included 205 patients that underwent surgery for adenocarcinoma of the esophagogastric junction Siewert Type II between 1990 and 2014 at our centres. Perioperative and follow-up data were collected prospectively and analyzed retrospectively for two time intervals (1990 – 2005 versus 2006 – 2014) to allow comparison over time.

Results:

81 patients underwent surgery between 1990 – 2005, 124 patients between 2006 – 2014. Overall, 68% of patients underwent an extended gastrectomy and 32% a thoraco-abdominal esophagectomy. Over time, we noticed an increase in esophagectomies with only 15% of patients receiving this therapy between 1990 – 2005, compared to 44% in the later period (p < 0,001). Further, use of neoadjuvant treatment increased significantly from 47 to 74% (p < 0,001). Analyses of postoperative complication rate showed a reduction of severe complications (Grade 4/5 – 1990 – 2005: 25,0% versus 2006 – 2014: 9,3%)) over the time period after esophagectomy, while complications after gastrectomy remained stable (1990 – 2005: 20,3% versus 2006 – 2014: 17,1%). 5-year survival was significantly better between 2006 – 2014 compared to the earlier period (51% versus 27%; p < 0,001). Multivariate analysis confirmed pUICC-stage (RR: 2.49, 95% CI: 1.66 – 3.75), resection margins (RR: 1.92, 95% CI: 1.15 – 3.20) and treatment period (RR: 1.67, 95% CI:1.13 – 2.46) as independent prognostic factors of long-term survival.

Conclusion:

We found an increased use esophagectomies for the treatment of adenocarcinoma of the esophagogastric junction Siewert Type II in our two University Hospitals within recent years. Despite the „higher extent of surgery” in this approach, long-term survival improved significantly over time.