Virchows Archiv

, Volume 446, Issue 5, pp 497–504

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

  • Marinke Westerterp
  • Linetta B. Koppert
  • Christianne J. Buskens
  • Hugo W. Tilanus
  • Fiebo J. W. ten Kate
  • Jacques J. H. G. M. Bergman
  • Peter D. Siersema
  • Herman van Dekken
  • Jan J. B. van Lanschot
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 esophagusGEJEarly cancerSubstageSurvival

Copyright information

© Springer-Verlag 2005

Authors and Affiliations

  • Marinke Westerterp
    • 1
  • Linetta B. Koppert
    • 2
  • Christianne J. Buskens
    • 1
  • Hugo W. Tilanus
    • 2
  • Fiebo J. W. ten Kate
    • 3
  • Jacques J. H. G. M. Bergman
    • 4
  • Peter D. Siersema
    • 5
  • Herman van Dekken
    • 6
  • Jan J. B. van Lanschot
    • 1
  1. 1.Department of SurgeryAcademic Medical Center at the University of AmsterdamAmsterdamThe Netherlands
  2. 2.Department of SurgeryErasmus University Medical CenterRotterdamThe Netherlands
  3. 3.Department of PathologyAcademic Medical Center at the University of AmsterdamAmsterdamThe Netherlands
  4. 4.Department of GastroenterologyAcademic Medical Center at the University of AmsterdamAmsterdamThe Netherlands
  5. 5.Department of Gastroenterology and HepatologyErasmus University Medical CenterRotterdamThe Netherlands
  6. 6.Department of Pathology, Josephine Nefkens InstituteErasmus University Medical CenterRotterdamThe Netherlands