Surgical treatment of primary esophageal adenocarcinoma

Objective: To study the biocharacteristics of primary esophageal adenocarcinoma (PEAC) and factorsinnuencing patients' prognosis and to find rationalsurgical indications and combined therapy. Methods: Toanalyze the clinical material of 106 patients with PEACand compared with that of patients with esophagealsquamous-cell carcinoma (ESCC). Results: The overallresectability, morbidity and 30-day mortality rates ofPEAC. were 92.5%, 23.5% and 2.8% respectively,similar to those of ESCC. The TNM staging, lymph nodemetastasis, extraesophageal invasion and the nature ofoperation were major determinants influencing longterm prognosis. The 5-year survival rate of PEAC was21.0%, which was lower than that of ESCC (P<0.01).Metastasis or recurrence remained to be the cause ofdeath in 82.4% of patients who lived longer than 5 years,which was higher than that of ESCC (P<0.01). Adjuvantradiation did not innuence survival of the patients withlymph node metastasis, but appeared helpful to thepatients with no lymph node metastasis. Conclusion:compared with ESCC, PEAC is a malignant disease withpoor prognosis. Surgical resection is the first and chiefchoice of treatment. Surgical indications includepatients in stage 0, I, II and some in stage III and even instage IVV of PEAC. Early detection, early diagnosis andearly treatment as well as radical operation couldimprove prognosis. Adjuvant radiotherapy appearshelpful only to the patients without lymph nodemetastasis.