AN OVERVIEW OF THE CURRENT STATUS OF LAPAROSCOPIC MANAGEMENT OF OESOPHAGO–GASTRIC JUNCTION TUMORS

Dr.Subbiah Shanmugham; Dr. A. Jagadish Singh

Volume : VIII, Issue : VI, June - 2019

AN OVERVIEW OF THE CURRENT STATUS OF LAPAROSCOPIC MANAGEMENT OF OESOPHAGO–GASTRIC JUNCTION TUMORS

Dr. Subbiah Shanmugham, Dr. A. Jagadish Singh

Abstract :

OBJECTIVE: To assess the outcome of surgical therapy based on a topographic/anatomical classification of esophagogastric junction tumours including squamous cell carcinoma and adeonocarcinoma after neoadjuvant chemo–radiotherapy. BACKGROUND: This study analyses the clinicopathological characteristics , surgical methods and response after neoadjuvant chemo–radiotherapy in oesophagogastric junction tumours. METHODS: The study reviewed the data of the major histological types of tumours involving oesophago–gastric junction in Tertiary cancer care centre from 2016–2018. Surgical patients were defined and classified according to AJCC 8TH manual . The data of 37 total patients diagnosed as involving oesophago–gastric junction were analysed. The collected data was recorded with emphasis on clinical features,pathological, endoscopic/imaging findings before neoadjuvant therapy. The study compared and analyzed the clinicopathological characteristics and the median survival rates of the tumor involving oesophago–gastric junction. Response after neoadjuvant chemo–radiotherapy was classified according to RECIST criteria. Among the surgery modes involving laparoscopic versus open methods the groups were subcategorised based on response assessement, nodal harvest and complications RESULTS: Among the 25 patients 23 patients were selected for surgery due to presence of residual disease by endoscopy/biopsy and imaging,17 were adenocarcinoma and 6 were squamous cell carcinoma. There were 4 patients with adenocarcinoma of the distal esophagus (Type I); 5 patients with true carcinoma of cardia (Type II); and 8 patients with subcardial carcinoma (Type III). Obvious differences were found in the clinicopathological characteristics of the three types of adenocarcinoma and squamous cell carcinomas, but no significant difference of the 1–year survival rates was found among the patients with curative resection adenocarcinoma and squamous cell carcinoma. Laparoscopic group of patients (total seven) experienced less complications in terms of lung complications and early start of oral feeds. CONCLUSION: On the data, the distribution of the three locations of adenocarcinoma was found to be different from that reported in Western countries(Type III being commonthan Type I). The squamous cell carcinoma prevalence was 26% as per our data. All oesophago–gastric junction tumours who had undergone curative resection were found to have similar 1–year survival rates. Laparoscopic surgery definitely improves post–operatively morbidity and less hospital stay with similar 1–year survival rate on comparison to open surgery methods.