Objectives Adenocarcinoma of the distal oesophagus and cardia (ADOC) are grouped among the thoracic tumors according to the TNM 7~ ed., however controversy is pending on the unique or dual pathogenesis (GORD or gastric-like cancerogenesis). We investigated the pathways of Iymphatic spreading in two cohorts of ADOC with or without Barrett's metaplasia. Methods ADOC + Barrett's (group 1) was diagnosed in 54 (subtotal oesophagectomy and oesophagogastrostomy at the neck or chest dome); no Barrett's was detected in 140 ADOC (group 2), (oesophagectomy at the azygos vein + total gastrectomy with Roux oesphagojejunostomy). A11 194 cases, were approached through a right thoracotomy and upper laparotomy. Radical Iymphadenectomy (stations 4L/R-34-7-10-8-9-15-16-17-18-19-20 TNM 7th ed. + pancreatic and pyloric nodes) was identical in both procedures except for the greater curvature stations. Results Histology confirmed the preop. Barrett-non Barrett grouping. Groups I and 2 were not different (p>0,05) for sex, age, mortality, morbidity, R0 resection rate and grading. They were different (p<0,05) for the number of patients with positive nodes (27/54 50% in group I and 98/140 70% in group 2), stage I (13/54 24% in group I and 4/140 3% in group 2), stage 3a4 (5/54 9°/O in group I and 44/140 31% in group 2). Median number (IQR) of resected nodes was 29 (15-36.5) in I and 30 (20-40) in 2 (p=.5 1). Distribution of pN+ and site of recurrence are reported in table 1. Survival of group I and 2 at Syrs is 42%, at 10yrs is 41% for group 1 and 36% for group 2 (log-rank p=0,679). Conclusions ADOC with Barrett's spreads preferentially to the thoracic stations opposite to ADOC without Barrett's which involves mostly perigastric nodes comprising the greater curvature's in 16.5%. The role of total gastrectomy should be questioned. These data deserve further investigation to improve surgery but possibly also surveillance programs. Disclosure: All authors have declared no conflicts of interest.
Ruffato A, Aramini B, D’Errico A, Lugaresi ML, Malvi D, Guiducci GM, et al. (2011). PN Status in adenocarcinoma of the distal oesophagus and cardia (ADOC). INTERACTIVE CARDIOVASCULAR AND THORACIC SURGERY, 13 Suppl. 1, F-199: 80-F-199: 80.
PN Status in adenocarcinoma of the distal oesophagus and cardia (ADOC)
RUFFATO, ALBERTO;ARAMINI, BEATRICE;D'ERRICO, ANTONIETTA;LUGARESI, MARIALUISA;MATTIOLI, SANDRO
2011
Abstract
Objectives Adenocarcinoma of the distal oesophagus and cardia (ADOC) are grouped among the thoracic tumors according to the TNM 7~ ed., however controversy is pending on the unique or dual pathogenesis (GORD or gastric-like cancerogenesis). We investigated the pathways of Iymphatic spreading in two cohorts of ADOC with or without Barrett's metaplasia. Methods ADOC + Barrett's (group 1) was diagnosed in 54 (subtotal oesophagectomy and oesophagogastrostomy at the neck or chest dome); no Barrett's was detected in 140 ADOC (group 2), (oesophagectomy at the azygos vein + total gastrectomy with Roux oesphagojejunostomy). A11 194 cases, were approached through a right thoracotomy and upper laparotomy. Radical Iymphadenectomy (stations 4L/R-34-7-10-8-9-15-16-17-18-19-20 TNM 7th ed. + pancreatic and pyloric nodes) was identical in both procedures except for the greater curvature stations. Results Histology confirmed the preop. Barrett-non Barrett grouping. Groups I and 2 were not different (p>0,05) for sex, age, mortality, morbidity, R0 resection rate and grading. They were different (p<0,05) for the number of patients with positive nodes (27/54 50% in group I and 98/140 70% in group 2), stage I (13/54 24% in group I and 4/140 3% in group 2), stage 3a4 (5/54 9°/O in group I and 44/140 31% in group 2). Median number (IQR) of resected nodes was 29 (15-36.5) in I and 30 (20-40) in 2 (p=.5 1). Distribution of pN+ and site of recurrence are reported in table 1. Survival of group I and 2 at Syrs is 42%, at 10yrs is 41% for group 1 and 36% for group 2 (log-rank p=0,679). Conclusions ADOC with Barrett's spreads preferentially to the thoracic stations opposite to ADOC without Barrett's which involves mostly perigastric nodes comprising the greater curvature's in 16.5%. The role of total gastrectomy should be questioned. These data deserve further investigation to improve surgery but possibly also surveillance programs. Disclosure: All authors have declared no conflicts of interest.I documenti in IRIS sono protetti da copyright e tutti i diritti sono riservati, salvo diversa indicazione.
