[Adenocarcinoma of the esophagogastric junction: association with Barrett esophagus and gastroesophageal reflux--surgical results in 122 patients].

Abstract

Objective: To investigate the surgical results of adenocarcinoma of the esophagus and esophagogastric junction and its relationship with gastroesophageal reflux disease (GERD) and Barrett's esophagus.

Background: The incidence of adenocarcinoma of the cardia is continuously rising. Specialized intestinal metaplasia in Barrett's esophagus seems to be the source of these tumors. Barrett's esophagus is end stage GERD. In experimental studies alkaline reflux give rise of Barrett's esophagus and adenocarcinoma.

Patients: 122 patients with adenocarcinoma of the cardia and 121 patients with squamous cell tumor of the esophagus.

Methods: All esophageal resections between 11/85 and 2/95 were retrospectively analyzed. The relationship of gastroesophageal reflux disease, Barrett's esophagus and malignancy was compared between both groups using parameters of case history and histological sections. Survival was analyzed for tumorstage, T-and N-stage and R-classification.

Results: 5.9% of the adenocarcinomas were stage I, 44.1% stage II, 41. 5% stage III and 8.5% stage IV. Heartburn, regurgitation, consumption of H2 blockers or Barrett's mucosa were significantly more frequent for adenocarcinomas. A 5 year survival of 100% was seen for stage I tumors. Invasion of t he muscular layer reduced survival to 50%, lymph node invasion to 20%. R0-resection had a survival of 40%.

Conclusions: A relationship of GERD and adenocarcinoma of the cardia seems to be likely in our cases. Most patients had advanced malignancy. Survival is good only for early cases. Prevention of tumor genesis with effective antireflux surgery in case of alkaline reflux seem to be the best therapeutic decision.