Signet Cell Adenocarcinoma of the Esophagogastric Junction: Multimodal Treatment and Extent of Resection

25 Feb 2021 05:00 07:00
Bordeaux

Patient Profile & Clinical Presentation

  • Patient: 61-year-old male

  • Clinical Presentation: Addressed for a malignant tumour of the EG junction diagnosed during the follow-up of Barrett’s esophagus.

  • Symptoms: Mild dysphagia with initial weight loss of 6 kg, dropped from 94 to 88 kg.

Pre-Therapeutic Workup

  • Diagnosis: Adenocarcinoma with signet cells extending from the distal third of the esophagus to the upper part of the small curvature.

  • Clinical Stage: cT3N+M0.

Course of Treatment

  • Pre-operative Chemotherapy: FLOT protocol, 4 cycles.

  • Surgery: Total eso-gastrectomy and coloplasty on June 17.

  • Postoperative Course: Uneventful postoperative course. Patient discharged on July 4.

Final Pathology

Final pathology demonstrated a ypT4aN3R0 adenocarcinoma.

Panel of Experts for Discussion

Surgery: Prof. Stéphane Bonnet (Pilot Center/Paris) | Prof. Stefan Mönig (Pilot Center/Geneva)

Pathology: Ass. Prof. Maria Westerhoff, University of Michigan – University Hospitals

Discussion Points

This case is the opportunity to discuss several problems which are not been resolved so far, concerning the particular cases of adenocarcinomas of the EG junction with signet cells.

  1. Preoperative chemotherapy: Is preoperative chemotherapy useful, as for the other types of adenocarcinomas?

  2. Extent of resection: How extensive should the resection be, considering the risk of R1 in case of limited resection?

  3. Coloplasty: What are the advantages and disadvantages of coloplasty as a substitute for the esophagus?

These points will be exposed and discussed with a selected panel of the experts.