The esophagogastric junction cancer: diagnosis and surgical treatment challenges.

Aim: To present our experience in esophagogastric cancer.

Material And Method: Fifty nine subjects with esophagogastric junction cancer (52 men and 7 women, aged between 41 and 74 years), selected from 79 esophageal cancer patients admitted in the last 20 years (1982-2002) were analysed. The diagnosis was established on the clinical picture (esophageal syndrome 54 cases, weight loss 51 cases, anemia 49 cases), on the imaging tests (chest X-ray, barium swallow and CT scan) and endoscopy. The delay of the diagnosis was more than 1 year in 71.5% of cases. 47 (79.7%) cases were operated on; we performed 18 resections (14 total esophagogastrectomies with end-to side esophagojejunostomy and 4 partial esophagogastrectomies with intrathoracic esophagogastrostomy), 24 gastrostomies and 5 exploratory laparotomies. The surgical approach was left thoracotomy with frenotomy in all 18 resectable cases. All resected cases were adenocarcinomas, belonging to the II B and III pTNM stages.

Results: refer only to the resected cases. We registered: fair evolution in 13 cases (72.2%), postoperative morbidity rate of 27.8% (5 cases) and postoperative mortality rate of 5.5% (1 case). We also registered the following long term survival: 7 cases less than 6 months, 6 cases between 6 months and 1 year, 3 cases between 1 and 3 years and 2 cases over 5 years.

Conclusions: 1. preoperative assessment of the local invasion and lymphatic spread is very difficult; 2. surgical exploration is the only certain method for the assessment of resectability; 3. left thoracotomy with VII or VIII rib resection and frenotomy is the best surgical approach; 4. total esophagogastrectomy with end-to side esophago-jejunostomy is the main surgical procedure in the esophagogastric junction cancers.