Adenocarcinoma of the Esophagogastric Junction: The Role of Abdominal-Transhiatal Resection

Abstract

The surgical strategy for adenocarcinoma of the esophagogastric junction is still controversial. The aim of this study was to evaluate surgical results of the abdominal-transhiatal approach for 100 consecutively operated type II and III cardia adenocarcinoma, to clarify clinicopathological differences between these tumors, and to define prognostic factors. A prospectively maintained database identified 100 consecutively operated patients with Siewert type II and III cardia adenocarcinoma. Survival was analyzed by the Kaplan-Meier method. Differences between subgroups and prognostic factors were evaluated by the log rank test and Cox regression. Concerning clinicopathological characteristics, only the incidence of T1-2 stage was significantly higher in Siewert II type (P = .006). A complete (R0) resection was obtained in 74 patients (74%). Overall postoperative mortality and morbidity rates were 6% and 28%, respectively. Overall actuarial 5-year survival rate in resected patients was 27.4% (median 27 months), with 20.6% for type II and 34 for type III cancers (P = .07). Considering R0 resections, overall actuarial 5-year survival rate was 33.9% (median 33 months), with 26.7% for type II and 40.5 for type III cancer (P = .06). Pathologic T and N stage and R status were independent prognostic factors by multivariate analysis, and Siewert type showed a trend toward significance. The abdominal-transhiatal approach is a safe surgical approach, allowing complete tumor resection and adequate lymphadenectomy in these patients. True carcinoma of the cardia may be a distinct clinical entity with a more aggressive natural history than subcardial gastric carcinoma.

Left Thoracoabdominal Approach in Surgical Treatment of Adenocarcinoma of the Esophagogastric Junction in the Northern Henan Province of China

“…In our study, the overall survival rates at 1 year and 2 years were 89.2 and 69%, respectively. The median survival was 27.1 months, which was consistent with the reference in which adenocarcinoma of the EGJ was removed via the abdominal-transhiatal approach [6]. Studies have shown that the survival of patients with gastric adenocarcinoma is related to the number of regional lymph nodes with metastases [39].…”

“…Surgery remains the standard care for adenocarcinoma of the EGJ. However, this tumor seems to constitute a distinct clinicopathological entity, and management remains controversial, especially as to the optimal surgical approach [6]. As a result, numerous randomized clinical trials have been conducted to evaluate the survival benefit of various treatment regimens [7,8,9].…”

Gastric Tube Reconstruction Reduces Postoperative Gastroesophageal Reflux in Adenocarcinoma of Esophagogastric Junction

“…The purpose of treatment is mostly palliative with expectation to prolong the life and improve the quality of life. Surgical treatment is the current treatment of choice for AEG patients [14]. Proximal gastrectomy and total gastrectomy through the abdominal approach have been widely used and proved to be a reliable surgical method for patients with types II and III AEG [3,14].…”

“…Surgical treatment is the current treatment of choice for AEG patients [14]. Proximal gastrectomy and total gastrectomy through the abdominal approach have been widely used and proved to be a reliable surgical method for patients with types II and III AEG [3,14]. Although there were reports [15] that noted high morbidity of the proximal gastrectomy with esophagogastric anastomosis, Harrison et al [16] reported that the long-term outcomes were not influenced by surgical procedures for proximal gastric cancer.…”

Surgical strategies in true adenocarcinoma of the esophagogastric junction (AEG II): thoracoabdominal or abdominal approach?

“…For AEG III tumors, transhiatal extended gastrectomy (THG) is proposed as the method of choice [8]. The optimal surgical strategy for AEG type II tumors remains unclear, some authors preferring an abdominal approach with THG, and other authors preferring a TAE [9][10][11][12][13][14][15]. In addition there are different possibilities for the surgical approach for TAE.…”