Computed Tomography Scan Evaluation for Resectability of Adenocarcinoma of the Esophagogastric Junction

Abstract

Most of the carcinomas located at the esophagogastric (EG) junction are adenocarcinomas (ACA) arising from the cardiac portion of the stomach. For those patients with squamous cell carcinomas, 20% of carcinomas were in the upper third portion of the esophagus, 62% in the middle third, and 16% in the lower third [1]. Apart from malignancy of the lower esophagus and EG junction, ACA is about three times as common as epidermoid carcinoma. Since ACA of the EG junction mostly arises from the cardia of the stomach and is able to invade upward into the esophagus, it shows the behavior of squamous cell carcinoma of the esophagus and ACA of the stomach. Radical surgical resection is the treatment of choice in managing this type of cancer. There have been several preoperative staging studies undertaken, resulting in resectability of only 49% (112/227) and 55% in operated on cases (112/204) in our unit between January 1981 and December 1983. The most common reason for unresectability was the invasion of perigastric vital structures. In an effort to avoid unnecessary exploration in patients with far advanced cancer, CT scan has been prospectively used as a preoperative staging modality in order to increase the operative resectability.