Staging of adenocarcinoma of the gastroesophageal junction

K. Parry, L. Haverkamp, R. C G Bruijnen, P. D. Siersema, G. J A Offerhaus, J. P. Ruurda, R. Van Hillegersberg

Research output: Contribution to journalArticle

Abstract

Background Clinical staging of adenocarcinoma of the gastroesophageal junction (GEJ) determines the curative treatment regimen containing either neoadjuvant chemotherapy or chemoradiotherapy followed by either gastrectomy or esophagectomy. The value of current diagnostic tools is a matter of debate. Methods A prospective database (2003-2013) was used to identify 266 consecutive patients with adenocarcinoma of the GEJ in order to evaluate the accuracy of endoscopic ultrasound (EUS) and computed tomography (CT) regarding tumor localization according to Siewert, nodal status and its consequences on treatment strategy. Results Overall accuracy in determining tumor localization was 73% for endoscopy/EUS and 61% for CT (p = 0.018). With endoscopy/EUS, the accuracy was 97%, 66% and 75% respectively for type I, II and III. With CT this was respectively 69%, 57% and 80%. The overall accuracy for determining N-status (N0/N+) per patient was 75% for EUS and 71% for CT. Accuracy for determining a positive nodal station in patients without neoadjuvant therapy was 77% for EUS and 71% for CT (p = 0.001). Accuracy for detecting positive upper mediastinal nodes was 80-92%, whereas for peritumoral and abdominal nodes this was 50-80% in both EUS and CT. In 8/266 patients (3%) the type of surgery changed due to intraoperative findings. A radical resection was performed in 233 patients (88%). Conclusions Despite the suboptimal accuracy of determining tumor localization with EUS and CT, in only a small number of patients an intraoperative change of surgical treatment was needed. EUS is superior to CT in determining nodal status and tumor localization in GEJ tumors.

Original languageEnglish (US)
Pages (from-to)400-406
Number of pages7
JournalEuropean Journal of Surgical Oncology
Volume42
Issue number3
DOIs
StatePublished - Mar 1 2016
Externally publishedYes

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Esophagogastric Junction
Adenocarcinoma
Tomography
Neoplasms
Endoscopy
Neoadjuvant Therapy
Esophagectomy
Chemoradiotherapy
Gastrectomy
Therapeutics
Databases
Drug Therapy

Keywords

  • Adenocarcinoma
  • Gastroesophageal junction
  • Lymph nodes
  • Tumor staging

ASJC Scopus subject areas

  • Oncology
  • Surgery

Cite this

Parry, K., Haverkamp, L., Bruijnen, R. C. G., Siersema, P. D., Offerhaus, G. J. A., Ruurda, J. P., & Van Hillegersberg, R. (2016). Staging of adenocarcinoma of the gastroesophageal junction. European Journal of Surgical Oncology, 42(3), 400-406. https://doi.org/10.1016/j.ejso.2015.11.014

Staging of adenocarcinoma of the gastroesophageal junction. / Parry, K.; Haverkamp, L.; Bruijnen, R. C G; Siersema, P. D.; Offerhaus, G. J A; Ruurda, J. P.; Van Hillegersberg, R.

In: European Journal of Surgical Oncology, Vol. 42, No. 3, 01.03.2016, p. 400-406.

Research output: Contribution to journalArticle

Parry, K, Haverkamp, L, Bruijnen, RCG, Siersema, PD, Offerhaus, GJA, Ruurda, JP & Van Hillegersberg, R 2016, 'Staging of adenocarcinoma of the gastroesophageal junction', European Journal of Surgical Oncology, vol. 42, no. 3, pp. 400-406. https://doi.org/10.1016/j.ejso.2015.11.014
Parry K, Haverkamp L, Bruijnen RCG, Siersema PD, Offerhaus GJA, Ruurda JP et al. Staging of adenocarcinoma of the gastroesophageal junction. European Journal of Surgical Oncology. 2016 Mar 1;42(3):400-406. https://doi.org/10.1016/j.ejso.2015.11.014
Parry, K. ; Haverkamp, L. ; Bruijnen, R. C G ; Siersema, P. D. ; Offerhaus, G. J A ; Ruurda, J. P. ; Van Hillegersberg, R. / Staging of adenocarcinoma of the gastroesophageal junction. In: European Journal of Surgical Oncology. 2016 ; Vol. 42, No. 3. pp. 400-406.
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abstract = "Background Clinical staging of adenocarcinoma of the gastroesophageal junction (GEJ) determines the curative treatment regimen containing either neoadjuvant chemotherapy or chemoradiotherapy followed by either gastrectomy or esophagectomy. The value of current diagnostic tools is a matter of debate. Methods A prospective database (2003-2013) was used to identify 266 consecutive patients with adenocarcinoma of the GEJ in order to evaluate the accuracy of endoscopic ultrasound (EUS) and computed tomography (CT) regarding tumor localization according to Siewert, nodal status and its consequences on treatment strategy. Results Overall accuracy in determining tumor localization was 73{\%} for endoscopy/EUS and 61{\%} for CT (p = 0.018). With endoscopy/EUS, the accuracy was 97{\%}, 66{\%} and 75{\%} respectively for type I, II and III. With CT this was respectively 69{\%}, 57{\%} and 80{\%}. The overall accuracy for determining N-status (N0/N+) per patient was 75{\%} for EUS and 71{\%} for CT. Accuracy for determining a positive nodal station in patients without neoadjuvant therapy was 77{\%} for EUS and 71{\%} for CT (p = 0.001). Accuracy for detecting positive upper mediastinal nodes was 80-92{\%}, whereas for peritumoral and abdominal nodes this was 50-80{\%} in both EUS and CT. In 8/266 patients (3{\%}) the type of surgery changed due to intraoperative findings. A radical resection was performed in 233 patients (88{\%}). Conclusions Despite the suboptimal accuracy of determining tumor localization with EUS and CT, in only a small number of patients an intraoperative change of surgical treatment was needed. EUS is superior to CT in determining nodal status and tumor localization in GEJ tumors.",
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