Diagnostics and clinical significance of esophageal metastasis of adenocarcinoma of the gastroesophageal junction

PATIENT AND METHODS: 174 patients who had cardiac adenocarcinoma were examined in the endoscopic laboratory of the Surgical Department between March 1, 1994 and October 29, 2002. In the course of the endoscopic examinations intramural metastases were found in 19 patients (10.9%). Of the patients with esophageal metastasis, five had type 1 tumor, 10 had type 2 tumor, and 4 had type 3 tumor of the Siewert-Stein categorization. 16 of the patients were male, 3 were female. Seven patients had only one metastasis in the oesophagus, in the other patients the number of metastases varied between 2-5. Surgical intervention: in 4 out of the 19 patients no surgical intervention was performed, because they had extended metastases. In 4 patients a tube was inserted surgically, 1 patient had gastrostomy, 1 patient had explorative laparotomy, and another patient had diagnostical laparoscopy. Eight patients had gastric and esophageal resection/gastrectomy for palliative reason. RESULTS: Survival data of six patients out of the 19 were not evaluated, because in 1 case there was a postoperative complication, and in five patients the time passed since the diagnosis was too short. Mean survival time: 1/ patients with tube insertion: 128.25 days; 2/ no-intervention cases: 248 days; 3/ after the gastrectomy: 164 days; 4/ after the explorative laparotomy: 180 days; 5/ after diagnostic laparoscopy: 108 days. 6/ after gastric and esophageal resection/gastrectomy: 474 days (211 days the shortest, 723 days the longest). In case of those patients, who underwent resection, the survival was longer and the quality of life was better than in the other groups. CONCLUSIONS: 1. The intramural esophageal metastases of the cardiac adenocarcinomas are detectable by a routine endoscopic examination and confirmed by histological investigation. 2. Esophageal metastases of cardiac adenocarcinomas occur in all the three types of the Siewert-Stein classification. 3. The metastasis on the oesophagus means a developed stage of the tumor. 4. The proper therapy--although it can only be palliative--will increase the survival time of acceptable quality for the patient. 5. There was no significant difference in the survival time of patients after the removal of different types of Siewert-Stein tumors.