World Journal of Surgery

, Volume 33, Issue 1, pp 95–103 | Cite as

Is Adenocarcinoma of the Esophagogastric Junction Different between Japan and Western Countries? The Incidence and Clinicopathological Features at a Japanese High-Volume Cancer Center

  • Shinichi Hasegawa
  • Takaki Yoshikawa
  • Haruhiko Cho
  • Akira Tsuburaya
  • Osamu Kobayashi



We clarified the incidence of adenocarcinoma of the esophagogastric junction (AEG) at a Japanese high-volume cancer center and its clinicopathological features between the Siewert subtypes.


Patients with AEG were selected from a prospective database of gastric and esophageal tumors established by Kanagawa Cancer Center. The Siewert subtypes were determined retrospectively by examining pathological pictures of the resected specimens and by evaluating the pathology and endoscopy findings.


From January 1986 to December 2005, 147 (4.0%) patients were determined to have AEG; 2,794 (75.8%) were diagnosed to be true gastric cancer, whereas 745 (20.2%) were true esophageal cancer. Of these 147 patients with AEG, 5 (3.4%) were classified as type I, 82 (55.8%) as type II, and 60 (40.8%) as type III tumors. The depth of tumor invasion was deeper and the nodal metastases were more frequent in type III compared with type II. The risk factors for nodal metastases included the depth and size of the tumor, but not the Siewert subtypes itself. Mediastinal nodal metastases were strongly influenced by a thoracotomy and the extent of the dissection. The pathological grade was higher in type III than in type II. Although the 5-year survival rate was significantly higher in type II than in type III tumors, the survival difference disappeared when the patients were restricted to an R0 resection, even though type III patients demonstrated a more advanced stage.


The proportions of AEG were strikingly different between Japan and western countries. Although each Siewert subtype had some different characteristics, nodal metastases were determined by both the tumor progression and the extent of the nodal dissection. An R0 resection was a key for the survival in AEG.


  1. 1.
    Powell J, McConkey CC (1990) Increasing incidence of adenocarcinoma of the gastric cardia and adjacent of sites. Br J Cancer 62:440–443PubMedGoogle Scholar
  2. 2.
    Devesa SS, Blot WJ, Fraumeni JF Jr (1998) Changing patterns in the incidence of esophageal and gastric carcinoma in the United states. Cancer 83:2049–2053PubMedCrossRefGoogle Scholar
  3. 3.
    Blot WJ, Devesa SS, Kneller RW et al (1991) Rising incidence of adenocarcinoma of the esophagus and gastric cardia. JAMA 265:1287–1289PubMedCrossRefGoogle Scholar
  4. 4.
    Okabayashi T, Gotoda T, Kondo H et al (2000) Early carcinoma of the gastric cardia in Japan: is it different from that in the West? Cancer 89:2555–2559PubMedCrossRefGoogle Scholar
  5. 5.
    Siewert JR, Stein HJ (1996) Carcinoma of the cardia: carcinoma of the gastroesophageal junction-classification, pathology and extent of resection. Dis Esophagus 9:173–182Google Scholar
  6. 6.
    Kodera Y, Yamamura Y, Shimizu Y et al (1999) Adenocarcinoma of the gastroesophageal junction in Japan: relevance of Siewert’s classification applied to 177 cases resected at a single institution. J Am Coll Surg 189:594–601PubMedCrossRefGoogle Scholar
  7. 7.
    Ichikura T, Ogawa T, Kawabata T et al (2003) Is adenocarcinoma of gastric cardia a distinct entity independent of subcardial carcinoma? World J Surg 27:334–338PubMedCrossRefGoogle Scholar
  8. 8.
    Yuasa N, Miyake H, Yamada T et al (2006) Clinicopathologic comparison of Siewert type II and III adenocarcinoma of the gastrointestinal junction. World J Surg 30:364–371PubMedCrossRefGoogle Scholar
  9. 9.
    Borrmann R, Geshwulste des Magens und Duodenums (1926) In: Henke F, Lubarsh O (eds) Handbuch der Spezieller Pathologischen Anatomie und Histologie, Vol 4, pt 1. Springer, Berlin, 865 pGoogle Scholar
  10. 10.
    Japanese Gastric Cancer Association (1998) Japanese classification of gastric carcinoma, 2nd English edn. Gastric Cancer 1:10–24PubMedCrossRefGoogle Scholar
  11. 11.
    Salvon-Harman JC, Cady B, Nikulasson S et al (1994) Shifting proportions of gastric adenocarcinomas. Arch Surg 129:381–389PubMedGoogle Scholar
  12. 12.
    Harrison LE, Karpeh MS, Brennan ME (1998) Total gastrectomy is not necessary for proximal gastric cancer. Surgery 123:127–130PubMedGoogle Scholar
  13. 13.
    Fein M, Fuchs KH, Ritter MP et al (1998) Application of the new classification for cancer of the cardia. Surgery 124:707–713PubMedCrossRefGoogle Scholar
  14. 14.
    De Manzoni G, Pedrazzani C, Pasini F et al (2002) Results of surgical treatment of adenocarcinoma of the gastric cardia. Ann Thorac Surg 73:1035–1040PubMedCrossRefGoogle Scholar
  15. 15.
    Siewert JR, Feith M, Stein HJ (2005) Biologic and clinical variations of adenocarcinoma at the esophago-gastric junction: relevance of a topographic-anatomic subclassification. J Surg Oncol 90:139–146PubMedCrossRefGoogle Scholar
  16. 16.
    Steven RD (2006) Adenocarcinoma of the esophagus and cardia: a review of the disease and its treatment. Ann Surg Oncol 13:12–30CrossRefGoogle Scholar
  17. 17.
    Sasako M, Sano T, Yamamoto S et al (2006) Left thoracoabdominal approach versus abdominal transhiatal approach for gastric cancer of the cardia or subcardia: a randomised controlled trial. Lancet Oncol 7:644–651PubMedCrossRefGoogle Scholar
  18. 18.
    Hulscher JB, van Sandick JW, de Boer AG et al (2002) Extended transthoracic resection compared with limited transhiatal resection for adenocarcinoma of the esophagus. N Engl J Med 347:1662–1669PubMedCrossRefGoogle Scholar

Copyright information

© Société Internationale de Chirurgie 2008

Authors and Affiliations

  • Shinichi Hasegawa
    • 1
  • Takaki Yoshikawa
    • 1
  • Haruhiko Cho
    • 1
  • Akira Tsuburaya
    • 1
  • Osamu Kobayashi
    • 1
  1. 1.Department of Gastrointestinal SurgeryKanagawa Cancer CenterYokohama CityJapan

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