Outcome of patients with cancer of the esophagogastric junction in relation to histology and surgical strategy

BACKGROUND/AIMS: The impact of histologic type and surgical strategy on survival of patients with cancer of the esophagogastric junction is debated. Thus, we evaluated the relationship between cancer histologic type (adenocarcinoma vs. squamous cell carcinoma) on long-term survival and the results of two different surgical techniques on outcome. METHODOLOGY: Two hundred and one patients with neoplasm of the esophagogastric junction were prospectively observed, and 133 patients (66%) underwent operation with curative intent. The results of two resective techniques, total gastrectomy with a thoraco-abdominal approach and total gastrectomy with a trans-hiatal approach were also compared in a subgroup with Siewert's type II and III cancer. RESULTS: Seventy-seven patients had an adenocarcinoma and 56 a squamous cell carcinoma. The 5-year proportion of survival was 35% in the adenocarcinoma group versus 40% in the squamous group (log-rank = 0.92), and the mean length of survival was 35 +/- 3 months and 34 +/- 5 months, respectively. The overall incidence of postoperative morbidity and the length of hospital stay were both significantly lower in the trans-hiatal group than in the thoraco-abdominal group (31% vs. 51%; p = 0.04; and 15.6 days vs. 23.2 days; p = 0.02 respectively), while the 5-year patient survival was 37% thoraco-abdominal approach and 42% in the trans-hiatal approach (log-rank = 0.62). CONCLUSIONS: In the present population, histologic type of the esophagogastric cancer was not a determinant factor for long-term survival. The transhiatal approach resulted in a better postoperative outcome without compromising surgical radicality and patient survival.