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JCOG 9502: Scheme
Pre-op. Randomization
institution,macroscopic type, clinical T
Abdominal (AT)
Total gastrectomy, D2
+ left upper paraaortic dissection
Thoraco-abdominal (LT)
Total gastrectomy, D2
+ left upper paraaortic
+ mediastinal dissection
Observation
if curative resection
Gastric carcinoma, esoph. inv. (<3 cm)
T2-4,N0-2, M0
TheRoyalMarsden
Overall Survival
0 .0
0 .1
0 .2
0 .3
0 .4
0 .5
0 .6
0 .7
0 .8
0 .9
1 .0
0
1
2
3
4
5
6
7
8
9
10
A群
Ｂ群
登録後年数
割
合
Years after randomization
Proportion surviving
AT: Abdominal (n=82)
LT: Thoraco-abd.
(n=85)
Sasako M. Lancet Oncol 2006
TheRoyalMarsden
Conclusions of JCOG 9502
Thoraco-abdominal approach is
not
recommended for tumors of Siewert’s
type 2 and 3.
TheRoyalMarsden
Health Related Quality of Life
after Surgery for Junctional Cancer
63 patients
20 Ext TG
43 TTO
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
Aim of Surgery for Junctional Cancer
R0 resection
Minimum 15 lymph nodes
5cm grossly normal in situ proximal oesophagus
TheRoyalMarsden
Surgical Options According to Type
Siewert Type I
TTO / THO
Siewert Type II TTO / THO / Ext TG
Siewert Type III Ext TG