J Gastric Cancer.  2012 Mar;12(1):36-42.

Outcomes of Abdominal Total Gastrectomy for Type II and III Gastroesophageal Junction Tumors: Single Center's Experience in Korea

• Kim KT
• Jeong O
• Jung MR
• Ryu SY
• Park YK

Abstract

PURPOSE
The aim of this study was to evaluate the surgical outcomes of abdominal total gastrectomy, without mediastinal lymph node dissection for type II and III gastroesophageal junction (GEJ) cancers.
MATERIALS AND METHODS
We retrospectively reviewed surgical outcomes in 67 consecutive patients with type II and III GEJ cancers that were treated by the surgical resection between 2004 and 2008.
RESULTS
Thirty (45%) patients had type II and 37 (55%) had type III tumor. Among the 65 (97%) patients with curative surgery, 21 (31%) patients underwent the extended total gastrectomy with trans-hiatal distal esophageal resection, and in 44 (66%) patients, abdominal total gastrectomy alone was done. Palliative gastrectomy was performed in two patients due to the accompanying peritoneal metastasis. The postoperative morbidity and mortality rates were 21.4% and 1.5%, respectively. After a median follow up of 36 months, the overall 3-years was 68%, without any differences between the Siewert types or the operative approaches (transhiatal approach vs. abdominal approach alone). On the univariate analysis, the T stage, N stage and R0 resection were found to be associated with the survival, and multivariate analysis revealed that the N stage was a poor independent prognostic factor for survival.
CONCLUSIONS
Type II and III GEJ cancers may successfully be treated with the abdominal total gastrectomy, without mediastinal lymph node dissection in the Korean population.

Keyword

Surgery; Esophagogastric junction; Stomach neoplasms; Korea

MeSH Terms

Esophagogastric Junction
Follow-Up Studies
Gastrectomy
Humans
Korea
Lymph Node Excision
Multivariate Analysis
Neoplasm Metastasis
Retrospective Studies
Stomach Neoplasms

Figure

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  Fig. 1 Lymph node metastasis at each regional station in the patients with type II and III tumors. These two tumor types had similar patterns of lymphatic spread, with most commonly involving the lymph node station 1, 2, and 3 nodes and the spread was directed toward the celiac nodes.

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