Adenocarcinoma of the Esophagus

Adenocarcinoma involving the distal esophagus usually is far advanced when the patient is first seen. Adenocarcinoma differs from squamous carcinoma of the esophagus since it is relatively unresponsive to radiation therapy or chemotherapy. Adenocarcinoma of the esophagus resembles gastric cancer in its tendency to form a bulky and locally invasive tumor with early regional lymph node metastases. It differs from gastric cancer in its tendency to spread proximally in the esophagus and in the relatively infrequent early involvement of the liver by metastases. From 1979-1986, 37 patients had resection for adenocarcinoma involving the distal esophagus. Thirty-three patients were diagnosed with American Joint Committee for Cancer Stage III or IV adenocarcinoma at the time of operation. Transhiatal esophagectomy in continuity with a proximal gastrectomy was done in 27 patients. Reconstruction was accomplished by cervical esophagogastrostomy using pedicled distal stomach. There were three postoperative deaths (30-day mortality rate: 8%). Anastomotic leak occurred in nine patients and caused significant morbidity in four patients. Eleven patients required dilation of the cervical anastomosis after operation for up to 6 months. Mediastinal recurrence affected three patients treated by transhiatal esophagectomy. The survival rate (Kaplan-Meier) was 44% at 1 year and 31% at 2 years. Resection of adenocarcinoma of the esophagus can be accomplished in most patients with acceptable risks of morbidity and mortality. Resection restores ability to swallow saliva and to consume a normal diet, and is associated with an appreciable improvement in the quality of life.