Surgical treatment of tumors of the proximal stomach with involvement of the distal esophagus

A 26-year experience with Siewert type III tumors

K. Robert Shen, Stephen D. Cassivi, Claude Deschamps, Mark S. Allen, Francis C. Nichols, W. Scott Harmsen, Peter C. Pairolero

Research output: Contribution to journalArticle

10 Citations (Scopus)

Abstract

Objective: A paucity of outcome data exists regarding patients with proximal stomach cancer involving the distal esophagus (Siewert type III tumors). This is especially true with regard to long-term survival rates after surgical intervention. Methods: Medical records were reviewed of all patients who underwent total gastrectomy and distal esophagectomy with Roux-en-Y esophagojejunostomy for Siewert type III tumors from January 1975 through December 2000. Results: There were 116 patients (93 men and 23 women). The median age was 66 years (range, 22-87 years). Pathologic stage was 0 (carcinoma in situ) in 1 patient, IB in 13 patients, II in 17 patients, IIIA in 34 patients, IIIB in 10 patients, and IV in 41 patients. Complete resection was achieved in 69 (59.5%) patients. Eleven (9.5%) patients were treated with neoadjuvant therapy, 49 (42.2%) received adjuvant therapy, and 6 (5.2%) received intraoperative radiation. Follow-up was complete in 114 (98.3%) patients, ranging from 1 to 281 months (median, 14 months). Operative mortality was 5.2%. Complications occurred in 51 (43.9%) patients. Clinically significant anastomotic leaks occurred in 15 (12.9%) patients. Median hospitalization was 13 days (range, 8-70 days). Median follow-up was 14 months (range, 1-281 months). Overall median survival was 434 days, with 1-, 5-, and 10-year survivals of 56.2%, 19.0%, and 13.5%, respectively. The only factor associated with increased hospital mortality was anastomotic leakage (P = .002). Incomplete resection, increased tumor stage and grade, and splenic involvement significantly worsened long-term survival. Conclusions: Total gastrectomy and distal esophagectomy for Siewert type III tumors is associated with reasonable mortality and significant morbidity. Although often palliative, surgical intervention can provide long-term survival, especially in patients with completely resected, early-stage, low-grade tumors.

Original languageEnglish (US)
JournalJournal of Thoracic and Cardiovascular Surgery
Volume132
Issue number4
DOIs
StatePublished - Oct 2006

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faropenem medoxomil
Esophagus
Stomach
Neoplasms
Therapeutics
Anastomotic Leak
Esophagectomy
Survival
Gastrectomy
Neoadjuvant Therapy
Mortality
Carcinoma in Situ
Hospital Mortality

ASJC Scopus subject areas

  • Cardiology and Cardiovascular Medicine
  • Surgery

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Surgical treatment of tumors of the proximal stomach with involvement of the distal esophagus : A 26-year experience with Siewert type III tumors. / Shen, K. Robert; Cassivi, Stephen D.; Deschamps, Claude; Allen, Mark S.; Nichols, Francis C.; Harmsen, W. Scott; Pairolero, Peter C.

In: Journal of Thoracic and Cardiovascular Surgery, Vol. 132, No. 4, 10.2006.

Research output: Contribution to journalArticle

Shen, K. Robert ; Cassivi, Stephen D. ; Deschamps, Claude ; Allen, Mark S. ; Nichols, Francis C. ; Harmsen, W. Scott ; Pairolero, Peter C. / Surgical treatment of tumors of the proximal stomach with involvement of the distal esophagus : A 26-year experience with Siewert type III tumors. In: Journal of Thoracic and Cardiovascular Surgery. 2006 ; Vol. 132, No. 4.
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title = "Surgical treatment of tumors of the proximal stomach with involvement of the distal esophagus: A 26-year experience with Siewert type III tumors",
abstract = "Objective: A paucity of outcome data exists regarding patients with proximal stomach cancer involving the distal esophagus (Siewert type III tumors). This is especially true with regard to long-term survival rates after surgical intervention. Methods: Medical records were reviewed of all patients who underwent total gastrectomy and distal esophagectomy with Roux-en-Y esophagojejunostomy for Siewert type III tumors from January 1975 through December 2000. Results: There were 116 patients (93 men and 23 women). The median age was 66 years (range, 22-87 years). Pathologic stage was 0 (carcinoma in situ) in 1 patient, IB in 13 patients, II in 17 patients, IIIA in 34 patients, IIIB in 10 patients, and IV in 41 patients. Complete resection was achieved in 69 (59.5{\%}) patients. Eleven (9.5{\%}) patients were treated with neoadjuvant therapy, 49 (42.2{\%}) received adjuvant therapy, and 6 (5.2{\%}) received intraoperative radiation. Follow-up was complete in 114 (98.3{\%}) patients, ranging from 1 to 281 months (median, 14 months). Operative mortality was 5.2{\%}. Complications occurred in 51 (43.9{\%}) patients. Clinically significant anastomotic leaks occurred in 15 (12.9{\%}) patients. Median hospitalization was 13 days (range, 8-70 days). Median follow-up was 14 months (range, 1-281 months). Overall median survival was 434 days, with 1-, 5-, and 10-year survivals of 56.2{\%}, 19.0{\%}, and 13.5{\%}, respectively. The only factor associated with increased hospital mortality was anastomotic leakage (P = .002). Incomplete resection, increased tumor stage and grade, and splenic involvement significantly worsened long-term survival. Conclusions: Total gastrectomy and distal esophagectomy for Siewert type III tumors is associated with reasonable mortality and significant morbidity. Although often palliative, surgical intervention can provide long-term survival, especially in patients with completely resected, early-stage, low-grade tumors.",
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AU - Cassivi, Stephen D.

AU - Deschamps, Claude

AU - Allen, Mark S.

AU - Nichols, Francis C.

AU - Harmsen, W. Scott

AU - Pairolero, Peter C.

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AB - Objective: A paucity of outcome data exists regarding patients with proximal stomach cancer involving the distal esophagus (Siewert type III tumors). This is especially true with regard to long-term survival rates after surgical intervention. Methods: Medical records were reviewed of all patients who underwent total gastrectomy and distal esophagectomy with Roux-en-Y esophagojejunostomy for Siewert type III tumors from January 1975 through December 2000. Results: There were 116 patients (93 men and 23 women). The median age was 66 years (range, 22-87 years). Pathologic stage was 0 (carcinoma in situ) in 1 patient, IB in 13 patients, II in 17 patients, IIIA in 34 patients, IIIB in 10 patients, and IV in 41 patients. Complete resection was achieved in 69 (59.5%) patients. Eleven (9.5%) patients were treated with neoadjuvant therapy, 49 (42.2%) received adjuvant therapy, and 6 (5.2%) received intraoperative radiation. Follow-up was complete in 114 (98.3%) patients, ranging from 1 to 281 months (median, 14 months). Operative mortality was 5.2%. Complications occurred in 51 (43.9%) patients. Clinically significant anastomotic leaks occurred in 15 (12.9%) patients. Median hospitalization was 13 days (range, 8-70 days). Median follow-up was 14 months (range, 1-281 months). Overall median survival was 434 days, with 1-, 5-, and 10-year survivals of 56.2%, 19.0%, and 13.5%, respectively. The only factor associated with increased hospital mortality was anastomotic leakage (P = .002). Incomplete resection, increased tumor stage and grade, and splenic involvement significantly worsened long-term survival. Conclusions: Total gastrectomy and distal esophagectomy for Siewert type III tumors is associated with reasonable mortality and significant morbidity. Although often palliative, surgical intervention can provide long-term survival, especially in patients with completely resected, early-stage, low-grade tumors.

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