Upper GI 2017

3/28/2017

JCOG 9502: Scheme

TheRoyalMarsden

Overall Survival

Gastric carcinoma, esoph. inv. (<3 cm) T2-4,N0-2, M0

1 .0

0 .9

A群 Ｂ群

0 .8

AT: Abdominal (n=82)

Pre-op. Randomization institution,macroscopic type, clinical T

0 .7

0 .6

割 合

0 .5

0 .4

Abdominal (AT) Total gastrectomy, D2 + left upper paraaortic dissection

Thoraco-abdominal (LT) Total gastrectomy, D2 + left upper paraaortic + mediastinal dissection

LT: Thoraco-abd. (n=85)

0 .3

0 .2

Proportion surviving

0 .1

0 .0

0

1

2

3

4

5

6

7

8

9

10

登録後年数 Years after randomization

Observation if curative resection

Sasako M. Lancet Oncol 2006

TheRoyalMarsden

TheRoyalMarsden

Conclusions of JCOG 9502

Health Related Quality of Life after Surgery for Junctional Cancer

63 patients

20 Ext TG 43 TTO

Thoraco-abdominal approach is not recommended for tumors of Siewert’s type 2 and 3.

Better baseline scores for TTO – fitter group

6/12 HQRL lower scores after TTO Role and Social Function Global Quality of Life Fatigue

Barbour et al 2008, BJS 95: 80- 4

TheRoyalMarsden

TheRoyalMarsden

Aim of Surgery for Junctional Cancer

Surgical Options According to Type

Siewert Type I

TTO / THO

R0 resection Minimum 15 lymph nodes 5cm grossly normal in situ proximal oesophagus

Siewert Type II TTO / THO / Ext TG

Siewert Type III Ext TG

13