الفهرس 
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Abstract
Significant changes in the management of carcinoma of esophagus and GEJ have been introduced over the past decades.
Preoperative treatments in the form of chemotherapy and chemoradiotherapy are now the gold standard of patients with locally advanced disease. There is an evidence that neoadjuvant therapies improve the prognosis of locally advanced GEJ carcinoma patients.
This is a prospective study which included 20 patients presenting with gastro-esophageal junction tumor to the General surgery and Oncology outpatient clinics of the Menoufia University Hospitals during the period from July 2017 to July 2020. Pretreatment staging and multidisciplinary group discussion were done for all patients. Preoperative chemotherapy ECX regimen (epirubicin, cisplatin, capecitabine) was planned for 3 to 4 cycles followed by surgery. All patients were allocated a clinical stage before and after preoperative chemotherapy and were compared to post-operative pathological stage. Follow up of patients was done for 2 years.
The results showed that the 2- year disease free survival of our studied group was between 24 to 40 months. Median time was 25.5 months and the mean was 28.30 ±5.17. The overall survival is the length of time from either the date of diagnosis or the start of treatment for a cancer that the patients diagnosed are still alive. Median overall survival was 30 months and the mean was 33.50 ±5.13.
There was significance improvement in the T and N stage after neoadjuvant chemotherapy. All patients were M0 with no distant metastases. T stage was T1-T2 in 6 patients (30%) while after the preoperative chemotherapy 12 patients were T1-T2. Also down staging of N stage was found. N2-N3 stage was in 16 patients before starting chemotherapy, but only 8 patients were N2-N3 after chemotherapy.
The Ivor - Lewis operation was performed on 30% of patients and the other 70% of patients had abdominal transhiatal extended gastrectomy. The choice of approach has depended on the ability to achieve negative proximal margin transhiattally. Operative time ranged from 120 minutes to 420 minutes. The mean operative time was 301 ± 86.86 minutes
Non surgical complication, in the form of DVT, was only in 2 patients (10%). Surgical complication as Anastomotic leak was in 6 patients (30%) which was minimal and managed conservatively. (nothing per oral, nasogastric tube, intavenous fluids and antibiotics). Chylothorax in 2 patients (10%) was managed by intercostals tube insertion, antibiotics and low fat diet.
Half of the patients have response to preoperative chemotherapy with 30% complete and 20% partial pathological response. There has been no significance between the 2 groups as regard age, sex or associated co-morbidities. The overall survival rate has not significantly affected by the response rates.
All non-responders were admitted to ICU due to poor general condition, while only two responder patients were admitted to ICU and this showed significance between both groups. Increase response to neoadjuvant chemotherapy was strongly correlated to lower drug toxicity which also leads to decrease ICU admission in the responder group.