SIEWERT I TYPE ESOGASTRIC JUNCTION ADENOCARCINOMA - COMPLETE THERAPEUTIC RESPONSE AFTER NEOADJUVANT TREATMENT

CLINICAL CASE

Abstract

The adenocarcinoma of the esogastric junction is a neoplasia with growing frequency in both US and Europe. We present a case study of a 43-year-old patient, smoker, that presented for the installation of dysphagia for both solids and liquids, weight loss (10 kg / 6 months), marked asthenia. Upper digestive endoscopy: starting from 32 cm from the dental arch, stenosing, budding tumoral formation, stretching up to the esogastric junction. Biopsies confirm the presence of moderately differentiated adenocarcinoma. Endoscopically, a metallic expandable esophageal stent is installed. PET-CT: important irregular parietal thickening with increased activity in the lower level of the thoracic esophagus, extending on the lesser curvature of the stomach; increased para esophageal lymph nodes (17 / 21cm) without increased metabolic activity, 2 node images with slightly increased activity. Neoadjuvant treatment is started using induction chemotherapy in order to trigger the sensitivity of the tumor, followed by targeted radiotherapy. The patient's condition is reassessed 6 weeks after neoadjuvant chemo radiotherapy and then surgery is practiced - subtotal esophagectomy with resection of the gastric lesser curvature by McKeown triple approach, 3 field lymphadenectomy, AKIYAMA type gastric pull-up, pyloroplasty, feeding jejunostomy. The histopathology of the resected specimen shows complete pathological response. The postoperative evolution is favorable, despite the fact that on the 5th postoperative day a respiratory complication occurs, bronchopneumonia, which is resolved under antibiotic treatment. Six months postoperatively, the patient shows no sign of loco-regional or distant relapse.