[Two Cases of Surgically Performed Radical Resection for Locally Advanced Adenocarcinoma of the Esophagogastric Junction].

Abstract

Background: A treatment policy for esophagogastric junction cancer is not well established in our country. In particular, there is an ongoing debate regarding treatment, including surgical procedures and chemotherapy, for locally advanced cases. Case 1: An 88-year-old male patient with a history of gastric cancer underwent upper gastrointestinal endoscopy, which revealed a type 2 advanced carcinoma on the lesser curvature of the residual stomach cardia. A biopsy confirmed the diagnosis of adenocarcinoma. Chest and abdominal CT showed enlarged lymph nodes, but no distant metastases. Based on the diagnosis of locally advanced adenocarcinoma of the esophagogastric junction(T3N+M0, cStage Ⅲ), laparoscopic total gastrectomy of the residual stomach was performed. During surgery, invasion into the diaphragmatic crus was suspected; therefore, combined resection was performed. Postoperative pathological examination revealed T3, Ly1b, V1b, N1, M0, and pStage Ⅱb. After surgery, the patient developed a mild pancreatic fistula, which improved with conservative treatment and he was discharged. Due to the patient's advanced age, adjuvant chemotherapy was not administered postoperatively, and there was no recurrence or metastasis 2 years after surgery. Case 2: A 68-year-old male patient presented with abdominal pain and a fever. Blood tests revealed elevated inflammatory marker levels. Abdominal CT revealed an abscess cavity in liver segments S6/7 and enlarged nearby lymph nodes, along with thickening of the wall extending from the lower esophagus to the gastric cardia. Gastrointestinal endoscopy revealed an ulcer with irregular surrounding elevation on the lesser curvature of the esophagogastric junction. A biopsy confirmed the diagnosis of adenocarcinoma. The liver abscess was drained, and cytology of the contents revealed no malignancy. Radical resection was performed using a transhiatal and right thoracic approach for a locally advanced adenocarcinoma of the esophagogastric junction(T4aN+M0, cStage Ⅲ). The postoperative pathological examination revealed T3, Ly1b, V1b, N2, M0, and pStage ⅢA. The patient's postoperative course was uneventful, and he was discharged. He is currently being administered adjuvant chemotherapy, and there has been no recurrence or metastasis 18 months after surgery.

Conclusion: We report 2 cases of locally advanced adenocarcinoma of the esophagogastric junction that were successfully treated with surgical resection.