Journal of Gastric Cancer

  • 제12권1호
  • /
  • Pages.36-42
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  • 2012
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  • 2093-582X(pISSN)
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  • 2093-5641(eISSN)
대한위암학회 (The Korean Gastric Cancer Association)
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Outcomes of Abdominal Total Gastrectomy for Type II and III Gastroesophageal Junction Tumors: Single Center's Experience in Korea

  • Kim, Kyoung-Tai (Division of Gastroenterologic Surgery, Department of Surgery, Chonnam National University Medical School) ;
  • Jeong, Oh (Division of Gastroenterologic Surgery, Department of Surgery, Chonnam National University Medical School) ;
  • Jung, Mi-Ran (Division of Gastroenterologic Surgery, Department of Surgery, Chonnam National University Medical School) ;
  • Ryu, Seong-Yeop (Division of Gastroenterologic Surgery, Department of Surgery, Chonnam National University Medical School) ;
  • Park, Young-Kyu (Division of Gastroenterologic Surgery, Department of Surgery, Chonnam National University Medical School)
  • 투고 : 2011.02.23
  • 심사 : 2012.03.07
  • 발행 : 2012.03.30
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초록

Purpose: The aim of this study was to evaluate the surgical outcomes of abdominal total gastrectomy, without mediastinal lymph node dissection for type II and III gastroesophageal junction (GEJ) cancers. Materials and Methods: We retrospectively reviewed surgical outcomes in 67 consecutive patients with type II and III GEJ cancers that were treated by the surgical resection between 2004 and 2008. Results: Thirty (45%) patients had type II and 37 (55%) had type III tumor. Among the 65 (97%) patients with curative surgery, 21 (31%) patients underwent the extended total gastrectomy with trans-hiatal distal esophageal resection, and in 44 (66%) patients, abdominal total gastrectomy alone was done. Palliative gastrectomy was performed in two patients due to the accompanying peritoneal metastasis. The postoperative morbidity and mortality rates were 21.4% and 1.5%, respectively. After a median follow up of 36 months, the overall 3-years was 68%, without any differences between the Siewert types or the operative approaches (transhiatal approach vs. abdominal approach alone). On the univariate analysis, the T stage, N stage and R0 resection were found to be associated with the survival, and multivariate analysis revealed that the N stage was a poor independent prognostic factor for survival. Conclusions: Type II and III GEJ cancers may successfully be treated with the abdominal total gastrectomy, without mediastinal lymph node dissection in the Korean population.

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참고문헌

  1. Parkin DM, Bray F, Ferlay J, Pisani P. Global cancer statistics, 2002. CA Cancer J Clin 2005;55:74-108. https://doi.org/10.3322/canjclin.55.2.74
  2. Blaser MJ, Saito D. Trends in reported adenocarcinomas of the oesophagus and gastric cardia in Japan. Eur J Gastroenterol Hepatol 2002;14:107-113. https://doi.org/10.1097/00042737-200202000-00003
  3. Lee JY, Kim HY, Kim KH, Jang HJ, Kim JB, Lee JH, et al. No changing trends in incidence of gastric cardia cancer in Korea. J Korean Med Sci 2003;18:53-57.
  4. Kim HJ, Kwon SJ. Analysis of clinocopathologic difference between type II and type III cancers in siewert classification for adenocarcinomas of the cardia. J Korean Gastric Cancer Assoc 2004;4:143-148. https://doi.org/10.5230/jkgca.2004.4.3.143
  5. Kodera Y, Yamamura Y, Shimizu Y, Torii A, Hirai T, Yasui K, et al. Adenocarcinoma of the gastroesophageal junction in Japan: relevance of Siewert's classification applied to 177 cases resected at a single institution. J Am Coll Surg 1999;189:594-601. https://doi.org/10.1016/S1072-7515(99)00201-X
  6. Park CH, Kang WK, Song KY, Bae JS, Kim JJ, Park SM, et al. Adenocarcinoma of the gastro-esophageal junction: Application of Siewert's classification to the Eastern experience. J Korean Gastric Cancer Assoc 2004;4:36-43. https://doi.org/10.5230/jkgca.2004.4.1.36
  7. von Rahden BH, Stein HJ, Siewert JR. Surgical management of esophagogastric junction tumors. World J Gastroenterol 2006;12:6608-6613. https://doi.org/10.3748/wjg.v12.i41.6608
  8. Bozzetti F, Bonfanti G, Bufalino R, Menotti V, Persano S, Andreola S, et al. Adequacy of margins of resection in gastrectomy for cancer. Ann Surg 1982;196:685-690. https://doi.org/10.1097/00000658-198212001-00012
  9. Ito H, Clancy TE, Osteen RT, Swanson RS, Bueno R, Sugarbaker DJ, et al. Adenocarcinoma of the gastric cardia: what is the optimal surgical approach? J Am Coll Surg 2004;199:880-886. https://doi.org/10.1016/j.jamcollsurg.2004.08.015
  10. Mattioli S, Di Simone MP, Ferruzzi L, D'Ovidio F, Pilotti V, Carella R, et al. Surgical therapy for adenocarcinoma of the cardia: modalities of recurrence and extension of resection. Dis Esophagus 2001;14:104-109. https://doi.org/10.1046/j.1442-2050.2001.00165.x
  11. Mariette C, Castel B, Toursel H, Fabre S, Balon JM, Triboulet JP. Surgical management of and long-term survival after adenocarcinoma of the cardia. Br J Surg 2002;89:1156-1163. https://doi.org/10.1046/j.1365-2168.2002.02185.x
  12. Tsujitani S, Okuyama T, Orita H, Kakeji Y, Maehara Y, Sugimachi K, et al. Margins of resection of the esophagus for gastric cancer with esophageal invasion. Hepatogastroenterology 1995;42:873-877.
  13. Siewert JR, Stein HJ. Classification of adenocarcinoma of the oesophagogastric junction. Br J Surg 1998;85:1457-1459. https://doi.org/10.1046/j.1365-2168.1998.00940.x
  14. Sobin LH, Wittekind C, International Union against Cancer, eds. TNM Classification of Malignant Tumours. 6th ed. New York: Willey-Liss, 2002.
  15. Japanese Gastric Cancer Association. Japanese Classification of Gastric Carcinoma - 2nd English Edition -. Gastric Cancer 1998;1:10-24.
  16. de Manzoni G, Pedrazzani C, Pasini F, Di Leo A, Durante E, Castaldini G, et al. Results of surgical treatment of adenocarcinoma of the gastric cardia. Ann Thorac Surg 2002;73:1035-1040. https://doi.org/10.1016/S0003-4975(01)03571-8
  17. Rudiger Siewert J, Feith M, Werner M, Stein HJ. Adenocarcinoma of the esophagogastric junction: results of surgical therapy based on anatomical/topographic classification in 1,002 consecutive patients. Ann Surg 2000;232:353-361. https://doi.org/10.1097/00000658-200009000-00007
  18. Siewert JR, Feith M, Stein HJ. Biologic and clinical variations of adenocarcinoma at the esophago-gastric junction: relevance of a topographic-anatomic subclassification. J Surg Oncol 2005;90:139-146. https://doi.org/10.1002/jso.20218
  19. Barbour AP, Rizk NP, Gonen M, Tang L, Bains MS, Rusch VW, et al. Adenocarcinoma of the gastroesophageal junction: influence of esophageal resection margin and operative approach on outcome. Ann Surg 2007;246:1-8. https://doi.org/10.1097/01.sla.0000255563.65157.d2
  20. Hulscher JB, van Sandick JW, de Boer AG, Wijnhoven BP, Tijssen JG, Fockens P, et al. Extended transthoracic resection compared with limited transhiatal resection for adenocarcinoma of the esophagus. N Engl J Med 2002;347:1662-1669. https://doi.org/10.1056/NEJMoa022343
  21. Sasako M, Sano T, Yamamoto S, Sairenji M, Arai K, Kinoshita T, et al; Japan Clinical Oncology Group (JCOG9502). Left thoracoabdominal approach versus abdominal-transhiatal approach for gastric cancer of the cardia or subcardia: a randomised controlled trial. Lancet Oncol 2006;7:644-651. https://doi.org/10.1016/S1470-2045(06)70766-5
  22. Kim SH, Karpeh MS, Klimstra DS, Leung D, Brennan MF. Effect of microscopic resection line disease on gastric cancer survival. J Gastrointest Surg 1999;3:24-33. https://doi.org/10.1016/S1091-255X(99)80004-3
  23. DeMeester SR. Adenocarcinoma of the esophagus and cardia: a review of the disease and its treatment. Ann Surg Oncol 2006;13:12-30. https://doi.org/10.1245/ASO.2005.12.025
  24. Carboni F, Lorusso R, Santoro R, Lepiane P, Mancini P, Sperduti I, et al. Adenocarcinoma of the esophagogastric junction: the role of abdominal-transhiatal resection. Ann Surg Oncol 2009;16:304-310. https://doi.org/10.1245/s10434-008-0247-x
  25. Casson AG, Darnton SJ, Subramanian S, Hiller L. What is the optimal distal resection margin for esophageal carcinoma? Ann Thorac Surg 2000;69:205-209.
  26. Pedrazzani C, de Manzoni G, Marrelli D, Giacopuzzi S, Corso G, Minicozzi AM, et al. Lymph node involvement in advanced gastroesophageal junction adenocarcinoma. J Thorac Cardiovasc Surg 2007;134:378-385. https://doi.org/10.1016/j.jtcvs.2007.03.034

피인용 문헌

  1. Comparison of the clinicopathological characteristics and the survival outcomes between the Siewert type II/III adenocarcinomas vol.31, pp.8, 2012, https://doi.org/10.1007/s12032-014-0116-3
  2. Comparisons of Clinical Outcomes and Prognoses in Patients With Gastroesophageal Junction Adenocarcinoma, by Transthoracic and Transabdominal Hiatal Approaches : A Teaching Hospital Retrospective Coh vol.94, pp.50, 2012, https://doi.org/10.1097/md.0000000000002277
  3. Comparison of survival outcomes between transthoracic and transabdominal surgical approaches in patients with Siewert-II/III esophagogastric junction adenocarcinoma: a single-institution retrospective vol.28, pp.4, 2012, https://doi.org/10.21147/j.issn.1000-9604.2016.04.04
  4. Laparoscopic-assisted versus open total gastrectomy for Siewert type II and III esophagogastric junction carcinoma: a propensity score-matched case-control study vol.31, pp.9, 2012, https://doi.org/10.1007/s00464-016-5375-y
  5. Epidemiology of Gastroesophageal Junction Adenocarcinoma in Korea vol.18, pp.4, 2012, https://doi.org/10.5230/jgc.2018.18.e38
  6. Outcomes of the Surgical Treatment for Adenocarcinoma of the Cardia – Single Institution Experience vol.52, pp.1, 2018, https://doi.org/10.1515/raon-2017-0039
  7. Novel abdominal approach for dissection of advanced type II/III adenocarcinoma of the esophagogastric junction: a new surgical option vol.47, pp.1, 2012, https://doi.org/10.1177/0300060518802923
  8. The optimal extent of lymph node dissection in gastroesophageal junctional cancer: retrospective case control study vol.19, pp.1, 2012, https://doi.org/10.1186/s12885-019-5922-8
  9. Adenocarcinoma of the Gastroesophageal Junction with Synchronous Renal Cell Carcinoma: A Case Report and Literature Review vol.47, pp.3, 2012, https://doi.org/10.2478/amb-2020-0028