Abstract
Objective: To assess the outcome of surgical therapy and choice of surgical strategy for patients with adenocarcinoma of the gastroesophageal junction. Methods: Between February 1989 and January 2005 during 16 years, 335 patients (65 female, 270 male, mean age 56 years) with esophagogastric junction adenocarcinoma underwent surgical operation. The choice of surgical approach was based on the anatomical location of the tumor mass. Outcome of surgery, histopathologic characteristics, demographic data and long term survival rates were compared among three types of tumor defined as follows.
Type I: Adenocarcinoma of the distal esophagus which infiltrates the esophagogastric junction from above. Type II: True carcinoma of the cardia arising immediately at the esophagogastric junction. Type III: Subcardial gastric carcinoma that infiltrates the esophagogastric junction and distal esophagus from below.
Results: Of the 335 patients undergoing resection, 110 (33%) had type I, 96 (28%) had type II, and 129 (39%) had type III. The preponderance of the male sex and the prevalence of metaplasia in distal esophagus decreased from type I to type III tumors (P<0.01). The prevalence of undifferentiated tumors increased from type I to type III tumors (P<0.01). Esophagectomy with resection of the proximal stomach for type I and extended total gastrectomy with transhiatal resection of the distal esophagus for type II and III were the primary procedures. The mean number of removed lymph node was higher in type III and II compared to type I tumors. The overall postoperative 30-day mortality was 8.4%. The death rate in transthoracic esophagectomy was higher than with extended total gastrectomy. Conclusions: The classification of adenocarcinoma of the esophagogastric junction into type I, II and III tumors helps in the selection of surgical approach. Type I tumors are approached as
distal esophageal cancer. Type III tumors are a special form of gastric cancer and treated as a gastric cancer. The relation of type II tumors to distal esophagus or proximal gastric cancer, however remains controversial. Esophagectomy offers no advantage over extended gastrectomy in patients with type II tumors if complete tumor resection and lymph-adenectomy can be achieved. (Rawal Med J 2007;32:150-155).

Key words: Adenocarcinoma, Esophagus adenocarcinoma, Transthoracic esophagectomy, Transmediastinal extended gastrectomy, Esophagogastric junction.