Outcomes of the surgical treatment for adenocarcinoma of the cardia – single institution experience

Stojan Potrc; Arpad Ivanecz; Bojan Krebs; Urska Marolt; Bojan Iljevec; Tomaz Jagric

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Outcomes of the surgical treatment for adenocarcinoma of the cardia – single institution experience

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| Sep 14, 2017

Radiology and Oncology

Volume 52 (2018): Issue 1 (March 2018)

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Published Online: Sep 14, 2017

Page range: 65 - 74

Received: Aug 15, 2017

Accepted: Aug 31, 2017

DOI: https://doi.org/10.1515/raon-2017-0039

© 2018 Stojan Potrc, Arpad Ivanecz, Bojan Krebs, Urska Marolt, Bojan Iljevec, Tomaz Jagric

This article is distributed under the terms of the Creative Commons Attribution Non-Commercial License, which permits unrestricted non-commercial use, distribution, and reproduction in any medium, provided the original work is properly cited.

Long-term survival after resection for adenocarcinoma of the cardia in regard to curability of the resection (R0 vs. R1/2) (n = 149, median survival in days: 846 ± 118 vs. 260 ± 107; HR = 0,223, Log Rank: p < 0001).

List of surgical (A) and general complications (B) occurring within 90 days after resection (n = 161)

	n	%
No complications	136	84.5
Intraabdominal abscess	6	3.7
Intraabdominal bleeding (within 48h)	4	2.5
Acute gangrenous cholecystitis	2	1.2
Leak from the esophagojejuno anastomosis	3	1.9
Enteric fistula	1	0.6
Disruption of laparotomy	1	0.6
Ileus	2	2.5
Ischemic colitis	1	0.6
Pancreatitis	4	2.5
Late rupture of pseudoaneurysm of splenic a.	1	0.6
Total complications	25	15.5

	n	%

No complications	127	78.9
Heard failure	9	5.5
Bronchopneumonia	11	6.8
Pneumo/ fluidothorax	3	1.9
Pulmonary embolia	2	1.2
Brain stroke	3	1.9
Febrile state of unknown origin	5	3.1
Decompensation of liver cirrhosis	1	0.6
Total complications	33	21.1

Multivariate analysis (Cox regression) for long-term survival after resection for adenocarcinoma of the cardia (n = 149, 90-day mortality excluded)

	B	HR	95,0% CI		p

			Lower	Upper
Multivisceral resection	-0.716	0.489	0.273	0.876	0.016
T < 3 vs. T> 2	-1.065	0.345	0.181	0.655	0.001
N 0 vs. N > 0	-0.620	0.538	0.307	0.942	0.030
Curability of resection (R)	0.747	2.110	1.359	3.276	0.001

Pattern of recurrence after resection of the cardia for adenocarcinoma (n = 149, 90-day mortality excluded)

	n	%

No recurrence	95	63.8
Infradiaphragmal local recurrence	24	16.1
Supradiaphragmal local recurrence	2	1.3
Liver metastases	8	5.4
Liver metastases and infradiaphragmal recurrence	8	5.4
Lung metastases	1	0.7
Lung metastases and infradiaphragmal recurrence	1	0.7
Lung metastases and supradiaphragmal recurrence	3	2.0
Liver and lung metastases	5	3.4
Dissemination - other (bones, neck)	2	1.3
Total	149

Clinicopathological characteristics of the patients resected for adenocarcinomas of the cardia (ACC)

Gender (n=161)	Male	120	74.5%
Gender (n=161)	Female	41	25.5%
Age(Mean, 95% CI) (n = 161)		64. 6 ± 10.1	Lower: 62.90	Upper: 66.31
American Society of Anesthesiology score (ASA) (n = 161)	1	53	32.9%
	2	83	51.6%
	3	25	15.5%
Type of resection (n=161)	Distal esophagectomy and total gastrectomy	136	84.5%
Type of resection (n=161)	Distal esophagectomy and proximal gastrectomy	25	15.5%
Extend of lymphadenectomy (n = 161)	D1	19	11.8%
Extend of lymphadenectomy (n = 161)	D2	142	88.2%
Metastatic lymph nodes(mean, 95% CI) (n = 161)		6.11 ± 7.7	Lower: 4.91	Upper: 7.32
All harvested lymph nodes(mean, 95% CI) (n = 161)		23.20 ± 11.7	21.37	25.03
Splenectomy (n = 161)		76	47.2%
Additional oncological resections		20	12.4%
R0 resection		154	95.7%
Proximal resection margin in mm(mean, 95% CI) (n = 142)		42.45 ± 20.7	Lower: 39.0	Upper: 45.80
Proximal resection margin < 20 mm (in fixed specimen + 0,9cm stapler ring) (n = 142)		9	5.6%
Diameter of the tumor in mm(mean, 95% CI) (n = 161)		63.16 ± 23.1	Lower: 58.18	Upper: 68.15
Any type of oncological treatment completed		56	34.8%

Type of additional oncological resections (n = 161)

	n	%
Left pancreatectomy	9	5.6
Liver resection	1	0.6
Local peritonectomy	6	3.7
Segmental resection of the jejunum	1	0.6
Resection of left suprarenal gland	2	1.2
Segmental colon resection	1	0.6
Total	20

Correlation for long-term survival in univariate analysis (Log Rank) for different clinicopathological characteristics. (n = 149, 90-day mortality excluded)

		Median survival (days)	HR	95% CI		p

				Lower	Upper
Splenectomy	No	1004 ± 148	1.502	0.998	2.260	0.049
Splenectomy	Yes	616 ± 168	1.502	0.998	2.260	0.049
Multivisceral resection	No	929 ±132	3.045	1.709	5.425	< 0.0001
Multivisceral resection	Yes	324 ± 158	3.045	1.709	5.425	< 0.0001
Gradus of the tumor	1	1377 ± 504
	2	855 ± 180	1.478	1.095	1.994	0.011
	3	613 ± 97
Perineural invasion	No	1308 ± 466	2.118	1.377	3.260	0.001
Perineural invasion	yes	660 ± 65	2.118	1.377	3.260	0.001
T stage	T1 and 2	3839 ± less than 50% of patients censored	4,147	2.297	7.488	< 0.0001
T stage	T3 and 4	611 ± 79	4,147	2.297	7.488	< 0.0001
N stage	N0	1915 ± 424	3.037	1.810	5.096	< 0.0001
N stage	> N0	540 ± 70	3.037	1.810	5.096	< 0.0001
Curability of the procedure (R)	R 0	846 ± 118	2.110	1.359	3.276	< 0 0001
Curability of the procedure (R)	R 1/2	260 ± 107	2.110	1.359	3.276	< 0 0001

Pathological classifications: depth of tumor infiltration (T), lymph node metastases (N), Lauren type, perinevral (n = 161)

		n	%
T0		1	0.6
T1		20	12.4
T2		21	13.0
T3		87	54.0
T4a		22	13.7
T4b		10	6.2
N0		48	29.8
N1		21	13.0
N2		41	25.5
N3a		33	15.6
N3b		18	11.2
Lauren type	Intestinal	97	67.8
	Diffuse	26	18.2
	mixed	20	14.0
Presence of perineural invasion		82	54.2

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Outcomes of the surgical treatment for adenocarcinoma of the cardia – single institution experience

Article Category: Research Article

Published Online: Sep 14, 2017

Page range: 65 - 74

Received: Aug 15, 2017

Accepted: Aug 31, 2017

DOI: https://doi.org/10.1515/raon-2017-0039

© 2018 Stojan Potrc, Arpad Ivanecz, Bojan Krebs, Urska Marolt, Bojan Iljevec, Tomaz Jagric

This article is distributed under the terms of the Creative Commons Attribution Non-Commercial License, which permits unrestricted non-commercial use, distribution, and reproduction in any medium, provided the original work is properly cited.

Figure 1

List of surgical (A) and general complications (B) occurring within 90 days after resection (n = 161)

Multivariate analysis (Cox regression) for long-term survival after resection for adenocarcinoma of the cardia (n = 149, 90-day mortality excluded)

Pattern of recurrence after resection of the cardia for adenocarcinoma (n = 149, 90-day mortality excluded)

Clinicopathological characteristics of the patients resected for adenocarcinomas of the cardia (ACC)

Type of additional oncological resections (n = 161)

Correlation for long-term survival in univariate analysis (Log Rank) for different clinicopathological characteristics. (n = 149, 90-day mortality excluded)

Pathological classifications: depth of tumor infiltration (T), lymph node metastases (N), Lauren type, perinevral (n = 161)