Current surgical treatment standards for esophageal and esophagogastric junction cancer

Jung, Minoa; Schmidt, Thomas; Chevallay, Mickaël; Berlth, Felix; Akiyama, Junichi; Gutschow, Christian A.; Mönig, Stefan P.

doi:10.1111/nyas.14454

Cited by 40 publications

(33 citation statements)

References 41 publications

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“…This is reflected in the vast differences in surgical approaches and long-term survival rates after surgical resection. 17 , 18 …”

Section: Discussionmentioning

confidence: 99%

Clinicopathological Characteristics and Survival Predictions for Adenocarcinoma of the Esophagogastric Junction: A SEER Population-Based Retrospective Study

Liu¹,

Jiang²,

Yue³

et al. 2021

IJGM

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Objective Adenocarcinoma of the esophagogastric junction (AEJ) is a relatively rare malignancy in Western countries whose specific clinicopathological characteristics and associated prognosis have not been comprehensively described. Methods Data on patients with AEJ between 2005 and 2015 in the Surveillance, Epidemiology, and End Results (SEER) database were extracted, evaluated, and compared with patients with gastric cancer (GC) in general. Overall survival (OS) was evaluated using the Kaplan–Meier method. Univariate and multivariate analyses were performed using the Cox proportional hazards regression model to identify risk factors predictive for OS, and the results were used to construct a nomogram to predict 1-, 3-, and 5-year OS among patients with AEJ. Results A total of 8013 patients diagnosed with AEJ were identified from the records of 30,179 patients with GC. The mean age was 65.4 (SD = 12.0) years, 79.5% were men, 87.2% were Caucasian, 91.5% were moderately-to-poorly differentiated, 34.4% had AJCC stage I AEJ, and 28.8% had stage IV. The median OS was 18 months, and the 5-year OS was 25.8% (95% CI: 24.8–26.8%). Fewer patients with AEJ had undergone surgical resection, fewer had T+ and N+ (N2~N3) disease ( P < 0.001), and fewer had distant metastases compared to the patients with GC ( P < 0.05). In the univariate and multivariate analyses, age, race, summary stage, N stage, M stage, and surgery were identified as independent risk factors. The nomogram had a calibration index of 0.726. Conclusion AEJ was found to have distinct clinicopathological characteristics. Age, race, summary stage, N stage, M stage, and surgery were independently associated with OS. The nomogram accurately predicted 1-, 3-, and 5-year OS rates.

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“…This is reflected in the vast differences in surgical approaches and long-term survival rates after surgical resection. 17 , 18 …”

Section: Discussionmentioning

confidence: 99%

Clinicopathological Characteristics and Survival Predictions for Adenocarcinoma of the Esophagogastric Junction: A SEER Population-Based Retrospective Study

Liu¹,

Jiang²,

Yue³

et al. 2021

IJGM

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“… 3 , 28 Moreover, the mechanisms of tumor development are different in these two diseases. 4 , 29 Considering the rising incidence of GEJ cancer worldwide, it is crucial to understand the specific prognostic factors for GEJ cancer patients. The results of this study suggest that the presence of HH is an important prognostic factor for patients with GEJ cancer.…”

Section: Discussionmentioning

confidence: 99%

“… 3 This may reflect the more difficult surgical approach required or the more complicated metastatic spread that occurs due to the anatomical features of the GEJ. 4 A recent Japanese multicenter cohort study undertook lymph node metastasis mapping in GEJ cancer patients. 5 This study recommended basing the extent of lymph node dissection on the estimated length of esophageal invasion.…”

Section: Introductionmentioning

confidence: 99%

The impact of hiatal hernia on survival outcomes in patients with gastroesophageal junction adenocarcinoma

Tanaka

Kinoshita

Akimoto

et al. 2021

Annals of Gastroent Surgery

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Aim A hiatal hernia (HH) complicates the diagnosis and surgical treatment of gastroesophageal junction (GEJ) cancer. This study aimed to investigate the effect of HH on the survival outcomes of GEJ cancer patients. Methods This single‐center study reviewed clinical data of 78 patients with GEJ adenocarcinoma who underwent R0 resection from 2008 to 2017. The patients were divided into two groups according to whether they presented with or without HH: the HH (+) group (n = 46) and the HH (−) group (n = 32). Results Patients in the HH (+) group were older than those in the HH (−) group (69.0 vs 67.5 years, P = .018). Regarding surgical outcomes, intra‐abdominal infectious complications was more common in the HH (+) group than in the HH (−) group (23.9% vs 9.4%, respectively; P = .089), particularly abscess formation (17.4% vs 3.1%, respectively; P = .036). Neither overall survival (OS) nor relapse‐free survival (RFS) differed between the two groups. However, survival rates were significantly worse in a subset of patients with T3‐4 disease (OS: log‐rank, P = .036) (RFS: log‐rank, P = .040) in the HH (+) group. In a multivariate analysis for OS in this cohort, HH was an independent prognostic factor (hazard ratio 3.60; 95% confidence interval 1.06‐11.9, P = .032). Conclusion Hiatal hernia may adversely affect surgical and survival outcomes in patients with GEJ cancer. Thus, surgical strategy must be carefully considered in these patients.

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“…Esophagectomy is one of the main methods to manage esophageal carcinoma ( 1 ). Ivor Lewis esophagectomy was firstly introduced in 1946 ( 2 ).…”

Section: Introductionmentioning

confidence: 99%

Double-Docking Technique, an Optimized Process for Intrathoracic Esophagogastrostomy in Robot-Assisted Ivor Lewis Esophagectomy

et al. 2022

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BackgroundThough robotic Ivor Lewis esophagectomy has been increasingly applied, intrathoracic esophagogastrostomy is still a technical barrier. In this retrospective study, we introduced a double-docking technique for intrathoracic esophagogastrostomy to optimize surgical exposure and facilitate intrathoracic anastomosis. Moreover, we compared the clinical outcomes between the double-docking technique and anastomosis with a single-docking procedure in robotic Ivor Lewis esophagectomy.MethodsFrom March 2017 to September 2020, the clinical data of 68 patients who underwent robotic Ivor Lewis esophagectomy were reviewed, including 23 patients who underwent the double-docking technique (double-docking group) and 45 patients who underwent single-docking robotic esophagectomy (single-docking group). All patients were diagnosed with esophageal cancer or gastro-esophageal junction by biopsy before surgery. The technical details of the double-docking technique are described in this article.ResultsThere was no difference in the patient demographics data between the two groups. The median surgical time in the double-docking group was slightly shorter than in the classic group without statistical difference (380 vs. 395 min, p = 0.368). In the double-docking group, the median blood loss was 90 mL, the median number of lymph nodes harvested was 17, and the R0 resection rates were 100% (23/23). There were no differences in the surgical outcomes between the two groups.ConclusionsBased on our experience, the double-docking technique provides good surgical exposure when fashioning anastomosis, and such a technique does not increase the surgical time. Therefore, we believe that the double-docking technique is a safe and effective method for intrathoracic esophagogastrostomy while providing good exposure and ensuring the convenience and reliability of intrathoracic anastomosis.

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Current surgical treatment standards for esophageal and esophagogastric junction cancer

Cited by 40 publications

References 41 publications

Clinicopathological Characteristics and Survival Predictions for Adenocarcinoma of the Esophagogastric Junction: A SEER Population-Based Retrospective Study

Clinicopathological Characteristics and Survival Predictions for Adenocarcinoma of the Esophagogastric Junction: A SEER Population-Based Retrospective Study

The impact of hiatal hernia on survival outcomes in patients with gastroesophageal junction adenocarcinoma

Double-Docking Technique, an Optimized Process for Intrathoracic Esophagogastrostomy in Robot-Assisted Ivor Lewis Esophagectomy

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