Clinicopathological characteristics and optimal management for esophagogastric junctional cancer; A single center retrospective cohort study

Background: esophagogastric junctional (egj) cancer occurs in the mucosa near the esophagogastric junction,and has characteristics of both esophageal and gastric malignancies; its optimal treatment strategy is controversial. methods: we conducted a single-center retrospective cohort study of the patients who underwent curative surgery with lymphadenectomy for egj cancer. tumor specimens were categorized by histology and location into four types-centered in the esophagus < 5 cm from egj (type e),which were subtyped as (i) squamous-cell carcinoma (sq) or (ii) adenocarcinoma (ad); (iii) any histological tumor centered in the stomach < 5 cm from egj,with egj invasion (type ge); (iv) any histological tumor centered in the stomach < 5 cm from egj,without egj invasion (type g)-and classified by tnm system; these were compared to patients' clinicopathological characteristics and survival outcomes. results: a total of 92 egj cancer patients were studied. median follow-up of surviving patients was 35.5 months. tumors were categorized as 12 type e (sq),6 type e (ad),27 type ge and 47 type g; of these 7 (58.3%),3 (50%),19 (70.4%) and 14 (29.8%) and 23 patients,respectively,had lymph node metastases. no patients with type e (ad) and ge tumors had cervical lymph node metastasis; those with type g tumors had no nodal metastasis at cervical and mediastinal lymph nodes. multivariate analysis showed that type e (ad) tumor was an independent prognostic factor. conclusions: we should distinguish type ge tumor from type e (ad) tumor because of the clinicopathological and prognostic differentiation. extended gastrectomy with or without lower esophagectomy according to tumor location and lower mediastinal and abdominal lymphadenectomy are recommended for egj cancer. © 2013 ito et al.