Relationship among modality of nodal metastasization and the presence/absence of intestinal metaplasia in the Esophagus (BE) and in the Stomach (GIM) for an Adenocarcinoma of the Esophagus and Cardia(ADEC)

Background: Pathogenesis of ADEC is controversial; we investigated the lymphatic spreading in a group of 194 patients consecutively operated upon for ADEC. Methods: Preoperatively patients underwent the hysthological search for BE in mucosa surrounding ADEC and GIM in the gastric corpus and antrum mucosa. Patients in which BE was documented underwent sub total esophagectomy and gastric pull up (group 1), others underwent esophagectomy at the azygos vein total gastrectomy with Roux Y esophagojejunostomy (group 2). Radical lymphadenectomy was identical in both procedures except for the greater curvature station. Results: Histology confi rmed the preoperative BE grouping which is reported with distribution of pNwithin the presence of BE in table 1. BE- tumors spread to the same abdominal stations with a higher rate of nodal metastases for GIMadenocarcinomas (p 0.001). Groups are not different (p 0,05) for sex, age, mortality, morbidity, R0 resection rate and grading. Median number (IQR) of resected nodes is 29 (15–36.5) in 1 and 30 (20–40) in 2 (p .51). GIM was detected in 4% of group 1 and in 36% of group 2 (p 0.001). 5 year overall survival is 42%; survival tends to be worst for BE- GIM-, better for BE- GIM. Discussion: Thoracic nodal stations were involved in group 1 only, opposite to perigastric and abdominal nodes that were predominantly involved in group 2, with a more aggressive nodal involvement for BE- GIM- tumors. These data suggest the existence of three different types of tumor in ADEC, further investigation is necessary. Disclosure: All authors have declared no confl icts of interest.