Nodal Status in Adenocarcinoma of the Esophagus an Cardia

University of Bologna

Status: Completed

Conditions: Adenocarcinoma of the Gastric Cardia; Adenocarcinoma of the Esophagus

Treatments: Procedure: Subtotal esophagectomy at the azygos vein, total gastrectomy; Procedure: Subtotal esophagectomy and gastric pull up

Study type: Observational

Funder types: Other

Identifiers

NCT01635595

Cardia AdCa UNIBO

Details and patient eligibility

About

Adenocarcinoma of the distal esophagus and cardia are grouped among the thoracic tumors according to the TNM 7th ed., however controversy is pending on the unique or dual pathogenesis (GERD or gastric-like cancerogenesis). It has been shown that biological patterns differ according to the presence (+) or absence (-) of Barrett's epithelium (BIM) and gastric intestinal metaplasia (GIM) in the fundus and antrum. Lymphatic metastatic spreading may differ according to the type of tumor. The investigators retrospectively investigated the pathways of lymphatic spreading in 194 consecutive patients who received radical surgery for adenocarcinoma of the esophagus and cardia with or without BIM and GIM.

Full description

The assumption that adenocarcinoma of the esophagus and cardia (ADEC) originates only from the sequence intestinal metaplasia followed by dysplasia and cancer is controversial. It has been shown that biological patterns differ according to the presence (+) absence (-) of Barrett's epithelium (BIM) and of gastric intestinal metaplasia (GIM) in the fundus and antrum. Lymphatic metastatic spreading may differ according to the type of tumor.

Preoperatively patients underwent histological search for Barrett's esophagus (BIM) in mucosa surrounding (ADEC) and intestinal metaplasia in the gastric corpus and antrum mucosa (GIM). Patients in which BIM was documented underwent sub total esophagectomy and gastric pull up (group 1), others underwent esophagectomy at the azygos vein + total gastrectomy with Roux Y esophagojejunostomy (group 2). Radical lymphadenectomy was identical in both procedures except for the greater curvature station.

Enrollment: 194 patients

Sex: All

Volunteers: No Healthy Volunteers

Inclusion criteria

• preoperative diagnosis of adenocarcinoma of the distal esophagus and cardia
• preoperative from local to locally advanced disease
• absence of neoadjuvant therapy

Exclusion criteria

• neoadjuvant therapy
• metastatic disease
• unfit for surgery

Trial design

194 participants in 2 patient groups

Patients with BIM

Description:

Patients affected by adenocarcinoma of the distal esophagus and cardia with preoperative diagnosis of BIM underwent subtotal esophagectomy and gastric pull up.

Treatment:

Procedure: Subtotal esophagectomy and gastric pull up

Patients without BIM

Description:

Patients affected by adenocarcinoma of the distal esophagus and cardia without preoperative diagnosis of BIM underwent subtotal esophagectomy at the azygos vein, total gastrectomy and esophagojejunostomy.

Treatment:

Procedure: Subtotal esophagectomy at the azygos vein, total gastrectomy