Background: Gastric cancer with esophageal invasion (GCE) is a disease of poor prognosis, and issues pertaining to surgical treatment still remain unresolved. Particularly problematic areas in GCE cases include the need for lower mediastinal lymph node (MSLN) dissection, the most effective surgical approach, and the optimal extent of the esophageal resection. In this study, we evaluate the characteristics of GCE and investigate aspects of surgical treatment.
Methods: Sixty-five patients with GCE were surgically treated in our department from 1990 to 2007. Fifty-two patients with M0 were evaluated for clinicopathological factors, disease recurrence pattern, and prognosis, and 47 patients with R0 resection were evaluated for operative factors.
Results: Patients with MSLN metastasis had significantly poor prognosis. The survival rate significantly differed among patients depending on T-factor, LN metastasis, MSLN metastasis, and lymphatic vessel invasion, but operative factors were not significant prognostic factors. Multivariate analysis indicated that T-factor and MSLN metastasis were independent prognostic factors. The peritoneum was the site of the highest recurrence rate (26.9%), followed by the liver (9.6%). Peritoneal recurrence correlated with T-factor and lymphatic vessel invasion and liver recurrence correlated with MSLN metastasis.
Conclusions: It seems that radical MSLN dissection and extended esophageal resection by thoracotomy have little therapeutic purpose for Siewert Types II or III tumors in GCE if the length of esophageal resection is within 6 cm. Patients with GCE have a poorer prognosis than those with common gastric cancer, and early detection and multimodal treatments for distant metastases are vital for ameliorating clinical outcome in patients with GCE.