Assessment and resection of carcinoma at the gastroesophageal junction.

In a five year retrospective study of 70 patients, the roentgenologic and surgical assessments of carcinoma at the gastroesophageal junction have been compared to the histologic findings of the resected specimens. Although the lesion was demonstrated roentgenologically in all patients, no reliable indication of its limits could be obtained, and spread was seriously underestimated by both preoperative barium studies and direct examination at operation. It is suggested that the lack of roentgenologic evidence may have encouraged an inadequate surgical approach and, thus, contributed to incomplete resection and the high immediate mortality. There is, at present, no satisfactory method by which spread can be defined, either before or at operation, and neither the preoperative barium studies nor his operative assessment should influence the surgeon to limit the resection.