Virchows Archiv

, Volume 446, Issue 5, pp 497–504

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

Authors

  • Marinke Westerterp
    • Department of SurgeryAcademic Medical Center at the University of Amsterdam
  • Linetta B. Koppert
    • Department of SurgeryErasmus University Medical Center
  • Christianne J. Buskens
    • Department of SurgeryAcademic Medical Center at the University of Amsterdam
  • Hugo W. Tilanus
    • Department of SurgeryErasmus University Medical Center
  • Fiebo J. W. ten Kate
    • Department of PathologyAcademic Medical Center at the University of Amsterdam
  • Jacques J. H. G. M. Bergman
    • Department of GastroenterologyAcademic Medical Center at the University of Amsterdam
  • Peter D. Siersema
    • Department of Gastroenterology and HepatologyErasmus University Medical Center
    • Department of Pathology, Josephine Nefkens InstituteErasmus University Medical Center
  • Jan J. B. van Lanschot
    • Department of SurgeryAcademic Medical Center at the University of Amsterdam
Original Article

DOI: 10.1007/s00428-005-1243-1

Cite this article as:
Westerterp, M., Koppert, L.B., Buskens, C.J. et al. Virchows Arch (2005) 446: 497. doi:10.1007/s00428-005-1243-1

Abstract

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.

Keywords

Barrett’s esophagus GEJ Early cancer Substage Survival

Copyright information

© Springer-Verlag 2005