Current trends in the surgical treatment of esophageal and cardia adenocarcinoma

Since adenocarcinoma of the esophagus and cardia is increasing at an alarmi ng rate, major efforts are currently oriented to identify patients who may benefit from extensive resection. Between November 1992 and May 1998, 218 p atients with histologically proven adenocarcinoma of the distal esophagus o r cardia were referred to our Department. In six patients (10.2%) with Barr ett's adenocarcinoma, cancer was discovered during endoscopic surveillance program for Barrett's metaplasia. Overall, one hundred-forty-seven patients (67%) underwent resection. Fifty-one underwent an extended mediastinal lym phadenectomy. Median cumulative survival was 25.9+/-3.1 months in patients undergoing resection, and 7+/-1.3 months in patients having palliation (p < 0.01). Survival was significantly longer in patients with negative nodes t han in those with lymph node metastases (54+/-12.9 versus 17+/-2.8 months, p < 0.01). Six of the 51 patients (11.8%) undergoing extended lymphadenecto my had metastatic upper mediastinal nodes. Additional serial sections and i mmunohistochemistry were performed in 46 patients. In 6 of 18 patients (33. 3%) with negative nodes at conventional hematoxylin-eosin examination, immu nohistochemistry demonstrated micrometastases in the lesser curve, paracard ial, peripancreatic, or lower mediastinal nodes. Early diagnosis remains th e prerequisite for curative treatment of adenocarcinoma of the esophagus an d cardia. When a curative resection is attempted, extended lymphadenectomy improves tumor staging and may prevent local recurrences. Serial sections a nd immunohistochemistry provide additional accuracy in the staging of the d isease and may prove useful to select patients for adjuvant therapy.