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

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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.

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Acknowledgements

The authors are grateful to W.C.J. Hop, PhD (Department of Epidemiology and Biostatistics, Erasmus University Medical Center, Rotterdam) for statistical advice.

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Authors and Affiliations

  1. Department of Surgery, Academic Medical Center at the University of Amsterdam, Amsterdam, The Netherlands

    Marinke Westerterp, Christianne J. Buskens & Jan J. B. van Lanschot

  2. Department of Surgery, Erasmus University Medical Center, Rotterdam, The Netherlands

    Linetta B. Koppert & Hugo W. Tilanus

  3. Department of Pathology, Academic Medical Center at the University of Amsterdam, Amsterdam, The Netherlands

    Fiebo J. W. ten Kate

  4. Department of Gastroenterology, Academic Medical Center at the University of Amsterdam, Amsterdam, The Netherlands

    Jacques J. H. G. M. Bergman

  5. Department of Gastroenterology and Hepatology, Erasmus University Medical Center, Rotterdam, The Netherlands

    Peter D. Siersema

  6. Department of Pathology, Josephine Nefkens Institute, Erasmus University Medical Center, PO Box 1738, 3000 DR, Rotterdam, The Netherlands

    Herman van Dekken

Authors
  1. Marinke Westerterp
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  2. Linetta B. Koppert
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  3. Christianne J. Buskens
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  4. Hugo W. Tilanus
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  5. Fiebo J. W. ten Kate
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  6. Jacques J. H. G. M. Bergman
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  7. Peter D. Siersema
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  8. Herman van Dekken
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  9. Jan J. B. van Lanschot
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Correspondence to Herman van Dekken.

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Westerterp, M., Koppert, L.B., Buskens, C.J. et al. Outcome of surgical treatment for early adenocarcinoma of the esophagus or gastro-esophageal junction. Virchows Arch 446, 497–504 (2005). https://doi.org/10.1007/s00428-005-1243-1

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  • DOI: https://doi.org/10.1007/s00428-005-1243-1

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