Ten-year Review of Patients with Resected Esophagogastric Junction Adenocarcinoma in the Philippine General Hospital

Abstract

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.