Surgical approach and results of surgery in adenocarcinoma of the gastro-oesophageal junction

Aim of Study: This paper attempts to determine the appropriate surgical procedure in relation to the pathological types of adenocarcinoma of the gastro-oesophageal junction in Singapore. Methods: Data on population characteristics, clinical presentation, pathology, surgical procedures and results of treatment were gathered from the case records of a personal series of 32 patients resected for adenocarcinoma of the gastro-oesophageal junction. Results: The 32 patients with adenocarcinoma of the gastro-oesophageal junction (Type 1, 9; II, 20 and III, 3), presented at a late stage (Stage I - II, 5; III, 14; IV, 13). In 19 patients with Stages I - III disease, attempted curative surgery was performed - extended total gastrectomy for Types II and III disease (13 patients) and oesophagectomy for Type I (6 patients). There was one operative mortality following curative resection. Palliative resection was performed on 13 patients with Stage IV disease with one operative mortality. The main bperative morbidity was anastomotic leakage, occurring in 5 patients; both operative deaths were associated with this complication. The actuarial 5-year survival was 20%. Conclusion: Although gastro-oesophageal cancer presents late, it can be resected safely by extended total gastrectomy for Types II and III disease and oesophagectomy for Type I disease, taking precautions to minimise anastomotic leakage. Although usually palliative, Stages I and II and to a lesser extent Stage III, are curable by these surgical procedures which ensure a tumour free surgical margin and adequate lymphadenectomy.