Clinicopathological Characteristics and Prognostic Factors of Patients with Siewert Type II Esophagogastric Junction Carcinoma: A Retrospective Multicenter Study: Reply
World J Surg
Clinicopathological Characteristics and Prognostic Factors of Patients with Siewert Type II Esophagogastric Junction Carcinoma: A Retrospective Multicenter Study: Reply
Tatsuo Matsuda 0
Hiroya Takeuchi 0
0 Department of Surgery, Keio University School of Medicine , 35 Shinanomachi, Shinjuku-ku, Tokyo 160-8582 , Japan
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Dear editor
We appreciate the valuable comments of Dr. Dimitrios
Schizas and colleagues as well as their interest in our
manuscript published in July 2016. In their letter, Schizas
et al. queried whether T4b esophagogastric cancer invaded
the aorta.
In our study, 122 patients (30.5%) were diagnosed with
T4 esophagogastric cancer, 17 of which were offered a R1
resection [
1
]. Unfortunately, in this retrospective
multicenter study, we did not collect data concerning adjacent
tissues that were invaded. Therefore, we are unable to
provide a definitive answer; however, it is the general
policy of our hospital to not offer surgery as treatment for
T4b with aorta invasion.
As we reported, the 5-year overall survival (OS) rate for
patients who underwent a R1 resection was 25.9% (that of
patients who underwent a R0 resection was 60.8%).
Furthermore, R1 resection was reported to be an independent
risk factor for poor OS in patients with pT4 esophageal
cancer [
2
]. Therefore, we are also interested in
stentgrafting in patients with T4b esophagogastric cancer that
penetrates into the aorta after chemo- or
chemoradiotherapy. This novel treatment modality should benefit at least
some patients and be less invasive compared to radical
esophagectomy combined with descending aorta
replacement [
3
]. However, as Schizas et al. mentioned, the
indication of intra-aortic stent-grafting should be carefully
discussed because of its high cost and relative invasiveness.
For example, patients with multiple lymph node metastases
1. Matsuda T , Kurokawa Y , Yoshikawa T , Kishi K , Misawa K , Ohi M et al ( 2016 ) Clinicopathological characteristics and prognostic factors of patients with siewert type II esophagogastric junction carcinoma: a retrospective multicenter study . World J Surg . 40 ( 7 ): 1672 - 1679
2. Shimada H , Shiratori T , Okazumi S , Matsubara H , Nabeya Y , Shuto K et al ( 2008 ) Have surgical outcomes of pathologic T4 esophageal squamous cell carcinoma really improved? Analysis of 268 cases during 45 years of experience . J Am College Surg 206 : 48 - 56
3. Cong Z , Diao Q , Yi J , Xiong L , Wu H , Qin T et al ( 2014 ) Esophagectomy combined with aortic segment replacement for esophageal cancer invading the aorta . Ann Thorac Surg 97 : 460 - 466 (...truncated)