J.Jpn. Surg. Soc.. 91(9): 1219-1222, 1990

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Report on the annual meeting

ON THE MEDIASTINAL FACTORS ABOUT ESOPHAGOCARDIAC CANCER

Fifty one patients with cancer around the esophagogastric junction admitted to the Second Department of Surgery Tohoku University School of Medicine. Of the forty two patients who undertook the resection of the main tumor, 22 had adenocarcinoma, 19 squamous cell carcinoma, 2 adenosquamous carcinoma and one malignant lymphoma. There was no significant difference in the background factors such as age, sex, pathological stage, type of operation between the adenocarcinoma and the squamous cell carcinomas.
The three types of mediastinal lymphnode dissection were performed: 1) Lymphnode dissection was limited within the abdomen. 2) The posterior mediastinal lymphnodes caudal to the bifurcation were dissected. 3) Almost all mediastinal nodes containing the upper posterior mediastinum were dissected.
Transesophageal mediastinal ultrasonography well documented the evidence and the nature of the metastatic nodes in the mediastinum.
Right and left cardiac and lesser curvature lymphnodes had a high rate of metastasis (20 to 40%). Three cases had metastatic lymphnodes in the upper mediastinum. There was no difference in metastatic pattern between adenocarcinoma and squamous cell carcinoma. The survival rate of the patients with the additional upper mediastinal dissection was not better significantly than that of those with the lower mediastinal dissection.
The remnant cancer tissue in the oral wall was proved in 6 cases (14%), but there was no recurrence of the cancer on the anastomotic site. Gamma-radiation on that site might be affected.
Adenocarcinoma patients showed a better prognosis than the squamous cell cancer patients. No postoperative adjuvant therapy improve the prognosis of the squamous cell cancer patients.

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