Clinical Trial Details
— Status: Completed
Administrative data
| NCT number |
NCT02302118 |
| Other study ID # |
AEG-II-esophagogastrectomy |
| Secondary ID |
|
| Status |
Completed |
| Phase |
N/A
|
| First received |
November 24, 2014 |
| Last updated |
December 2, 2015 |
| Start date |
April 2013 |
| Est. completion date |
November 2015 |
Study information
| Verified date |
December 2015 |
| Source |
Universitätsklinikum Hamburg-Eppendorf |
| Contact |
n/a |
| Is FDA regulated |
No |
| Health authority |
Germany: Ministry of Health |
| Study type |
Observational
|
Clinical Trial Summary
Comparison of the oncological outcome of patients who underwent esophagogastrectomy versus
extended gastrectomy due to carcinomas of the esophagogastric junction (Siewert type II)
Description:
The esophagogastric junction (EGJ) is an anatomical region where different tumour entities
which should be treated with different surgical approaches. Carcinomas within this area
cause discordance concerning the classification due to the topographical borderland between
the esophagus and the stomach. The definition, classification and staging of adenocarcinomas
of the esophagogastric junction (AEG) have been inconsistent and are challenging. Siewert
provided a system for classifying the tumours into three types based on
topographical-anatomical criteria with direct impact on therapeutic strategies and wide
acceptance in Europe. Adenocarcinomas of the esophagogastric junction type I involve the
distal esophagus and mostly arise in intestinal metaplasia of Barrett's esophagus; AEG type
II originates at the anatomical cardia and AEG type III are subcardial gastric carcinomas
infiltrating the esophagogastric junction and distal esophagus from below. The mix of
esophageal and gastric classification systems and especially, the controversy of the cell of
origin of AEG type II present significant difficulties in defining this entity. The 7th
edition of the American Joint Committee on Cancer/Union Internationale Contre Cancer
(AJCC/UICC) classification presented a new definition of AEG in 2009. A tumour is classified
as esophageal as soon as it extends into the esophagus and its epicentre is located within
5cm of the esophagogastric junction. Thus, Tumours with an epicentre in the stomach and
distance greater than 5cm from the esophagogastric junction (EGJ) or those within 5cm of the
EGJ but without extension into the esophagus are staged as gastric carcinoma. Most of the
cardia carcinomas which originally were staged according to the gastric cancer TNM
classification are now staged according the esophageal carcinoma TNM classification.
Accurate preoperative staging of Siewert type II tumours is a challenge. Apparently, AEG
type II show a specific biology with a high rate of lymph node metastases in comparison to
distal esophageal carcinomas. The optimal surgical approach ranges from extended gastrectomy
to radical esophagogastrectomy. In our opinion, an esophagogastrectomy with colonic
interposition could be suggested as an appropriate approach in AEG type II. Therefore, we
analyzed the oncological outcome of patients who underwent esophagogastrectomy versus
extended gastrectomy due to carcinomas of the esophagogastric junction (Siewert type II).
