Possible indication for surgical treatment of squamous cell carcinomas of the esophagus that involve the stomach

• Published in: Surgery 2003-05, Vol.133 (5), p.479-485
• Main Authors: Doki, Yuichiro, Ishikawa, Osamu, Kabuto, Toshiyuki, Hiratsuka, Masahiro, Sasaki, Yo, Ohigashi, Hiroaki, Kameyama, Masao, Murata, Kohei, Yamada, Terumasa, Miyashiro, Isao, Yokoyama, Shigekazu, Imaoka, Shingi
• Format: Article
• Language: English
• Subjects: Biological and medical sciences; Carcinoma, Squamous Cell - pathology; Carcinoma, Squamous Cell - surgery; Esophageal Neoplasms - pathology; Esophageal Neoplasms - surgery; Esophagectomy - mortality; Gastrectomy - mortality; Gastroenterology. Liver. Pancreas. Abdomen; Hospital Mortality; Humans; Lymph Nodes - pathology; Lymphatic Metastasis - pathology; Medical sciences; Neoplasm Invasiveness; Neoplasm Recurrence, Local; Stomach - pathology; Stomach - surgery; Stomach, duodenum, intestine, rectum, anus; Stomach. Duodenum. Small intestine. Colon. Rectum. Anus; Surgery (general aspects). Transplantations, organ and tissue grafts. Graft diseases; Surgery of the digestive system; Survival Analysis; Tumors
• ISSN: 0039-6060; 1532-7361
• DOI: 10.1067/msy.2003.134

Background. The caudal spread of esophageal squamous cell carcinoma (ESCC) frequently involves the stomach. An extended surgical treatment may provide a tumor-free margin; however, its clinical benefit has not been elucidated. Methods. Sixty-three of 582 patients with ESCC (11%) had massive gastric involvement and underwent esophagectomy with combined resection of the stomach and other organs. The mode of gastric involvement was classified as direct invasion from primary tumor (PT invasion) or invasion from metastatic lymph nodes (LN invasion). Results. In addition to the removal of either the proximal (83%) or the whole (17%) stomach, 46 patients (73%) underwent the combined resection of adjacent organs, including the diaphragm, pancreas, liver, lung, and pericardium. This surgical treatment resulted in a high rate (83%) of curative resection and a low rate (8%) of operative mortality. Postoperative survival rates were 53%, 33%, and 25% at 1, 2, and 5 years, respectively. The first tumor recurrence was frequently in the abdominal paraaortic lymph nodes (41%) and the liver (28%), followed by the mediastinal lymph nodes, local recurrence, the lung, and other organs. The mode of gastric involvement strongly affected clinical outcome, with a 5-year survival rate of 36% for those with PT invasion but of only 7% with LN invasion (P