1.Ten-year review of patients with resected esophagogastric junction adenocarcinoma in the Philippine General Hospital.
Shiela S. Macalindong ; Arturo S. Dela Pena ; Brian Buckley
Acta Medica Philippina 2021;55(4):387-397
OBJECTIVE:
To describe the clinicopathologic profile, management, and outcomes of patients with esophagogastric
junction (EGJ) adenocarcinoma in the local setting.
METHODS:
Data was obtained from patients who had curative surgery for EGJ adenocarcinoma from 2004–2013 in
the Philippine General Hospital. We used student's T-tests, analysis of variance, chi-squared and Fisher’s exact tests
for comparisons and Cohen’s kappa index for correlation. A P value of less than or equal to 0.05 was considered
significant.
RESULTS:
We included 88 patients (81.2% male) with mean age of 55.2 years. Eight percent were clinical Siewert
type I; 23.9% were type II; 15.9% were type III; and majority (52.3%) were unknown type. Surgical approach and
resection differed across the Siewert types (P<0.000). Thoracoabdominal approach (72.7%) and distal esophagectomy
with total gastrectomy (77.3%) were the most common procedures. Many had at least pathologic T3 (80.6%), N2
(54.5%), and stage III (68.2%) disease. Neoadjuvant and adjuvant chemotherapy was given in 1.2% (1/82) and 48.6%
(18/37), respectively. In-hospital morbidity was 40%; mortality was 4.5%; 1-year disease-free survival rate was 69.4%;
and overall survival rate was 76.5%. Correlation was fair between preoperative and pathologic Siewert type (P=0.003)
and poor between clinical and pathologic stage (P=0.115). Patients with recurrence had higher pathologic lymph
nodes (P=0.029) and more advanced stage (P=0.022).
CONCLUSION
EGJ adenocarcinomas were locally advanced and had poor outcomes. Surgery should be individualized
and multimodality approach considered.