&lt;p&gt;Short-Term and Long-Term Outcomes Following Transhiatal versus Right Thoracoabdominal Resection of Siewert Type II Adenocarcinoma of the Esophagogastric Junction&lt;/p&gt;

Xing, Jiadi; Liu, Maoxing; Xu, Kai; Gao, Pin; Tan, Fei; Yao, Zhendan; Zhang, Nan; Yang, Hong; Zhang, Chenghai; Cui, Ming; Su, Xiangqian

doi:10.2147/cmar.s275569

Cited by 9 publications

(18 citation statements)

References 31 publications

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“…It has been reported that the incidence of postoperative complications of a transthoracic approach for AEG II is signi cantly higher than that of a transabdominal approach (7,14,15). In our study, the incidence of complications was signi cantly higher in the TT group than in the TH group (17.48% vs. 8.04%, P = 0.028), which may be explained by the fact that the transthoracic approach leads to more mechanical lung injury.…”

Section: Discussionmentioning

confidence: 43%

Transthoracic Approach vs Transhiatal-Abdominal Approach in the Treatment of Locally Advanced Siewert Type II Esophagogastric Junctional Adenocarcinoma: A Retrospective Study

Zhu

Zhou

et al. 2021

Preprint

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Background The surgical approach for Siewert type II adenocarcinoma of the esophagogastric junction still remains controversial. This study aims to compare the differences between transthoracic approach and transhiatal-abdominal approach.Methods Patients with Siewert type II adenocarcinoma of the esophagogastric junction underwent surgery from January 2010 to July 2015 were analyzed retrospectively. They were divided into transthoracic approach group and transhiatal-abdominal approach group. Postoperative complications, surgical characteristics and 5-year survival rates of the two groups were compared by Chi-square test and log-rank test respectively, and the extent of gastrectomy was analyzed in subgroups. Finally, Cox univariate and multivariate analyses were conducted to predict the independent prognostic factors for long-term survival.Result A total of 255 patients with Siewert type II adenocarcinoma of the esophagogastric junction were analyzed, 143 with transthoracic approach group, 112 with transhiatal-abdominal approach group and the 5-year survival rate was 37.8% and 40.2% respectively (P=0.575). The incidence of positive proximal margins (0.70% vs. 6.25%, P=0.023) and intraoperative bleeding volume (175.15 ± 110.44 vs. 206.57 ± 131.97 ml, P=0.046) in transthoracic approach group were lower. Transhiatal-abdominal approach group had fewer pulmonary infection (8.04% vs. 17.48%, P=0.028) and shorter hospitalization time (11.32 vs. 12.67 days, P=0.008). In subgroup analysis, the 5-year survival rate of patients treated with partial gastrectomy was better than that of patients treated with total gastrectomy (44.8% vs. 36.1%, P=0.038). Conclusion Our study shows no significant difference between the two groups with regard to long-term survival. The transthoracic approach had more advantages for proximal margin and mediastinal lymph node dissection, while the transabdominal approach had less trauma to patients. Partial gastrectomy may be sufficient for patients with locally advanced disease. T stage and N stage were independent risk factors for long-term survival.

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Section: Discussionmentioning

confidence: 43%

Transthoracic Approach vs Transhiatal-Abdominal Approach in the Treatment of Locally Advanced Siewert Type II Esophagogastric Junctional Adenocarcinoma: A Retrospective Study

Zhu

Zhou

et al. 2021

Preprint

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“…The treatment for thoracic surgeons usually complies with guidelines of esophagus carcinoma, the TA approach could ensure radical oncology resection for tumor margins and adequate lymphadenectomy, leading to a potential survival advantage [19,31]. Abdominal surgeons usually consider the TH approach as a minor invasion and quicker recovery method [12,32].…”

Section: Discussionmentioning

confidence: 99%

“…Recent work by Xing et al retrospectively collected 211 Siewert type II AEG patients and compared the surgical approaches between the transhiatal and the right thoracoabdominal. As a result, the transhiatal group performed significantly better survival and fewer complications than that in the right thoracoabdominal group, as evidenced by propensity score matching (PSM) analysis [32]. Nevertheless, the credibility of these results should be treated with caution, as for the retrospective design and relatively small size.…”

Section: Discussionmentioning

confidence: 99%

The abdominal-transhiatal surgical approach versus the thoracoabdominal surgical approach in Siewert type II adenocarcinoma of the esophagogastric junction: protocol for a multicenter prospective, open, parallel, and randomized controlled trial

Song

et al. 2022

BMC Cancer

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Background To date, Siewert type II adenocarcinoma of the esophagogastric junction (ST-II AEG) can be removed radically utilizing either the abdominal-transhiatal (TH) or the right thoracoabdominal (RTA) approaches. Because of a paucity of high-quality direct evidence, the appropriate surgical approach for ST-II AEG remains debatable. In the present, only several retrospective studies are available, representing ambiguous results. Thus, prospective randomized clinical trials are demanded to compare the survival, oncological outcomes, safety and efficiency and life quality between the TH and RTA approach in patients with resectable AEG of Siewert type II. Methods A prospective, multicenter, open, randomized, and parallel controlled study named S2AEG will be conducted. Three hundred and twelve patients who match the inclusion criteria but not the exclusion criteria will be participating in the trial and randomly divided into the TH (156) and RTA (156) cohorts. The primary efficacy endpoint is the 3-year disease-free survival (DFS) following the operation. The rate of R0-resection, the number and site of lymph nodes infiltrated and dissected, postoperative complications, hospital days and life quality are the second endpoints. Discussion This study is the first prospectively randomized controlled trial aiming to compare the surgical outcomes between TH and RTA approaches in patients with resectable ST-II AEG. It is hypothesized that patients in the TH cohort would harvest equivalent oncological results and survival while maintaining acceptable life quality when compared to patients in the RTA cohort. Our findings will provide high-level clinical evidence for clinical decision-making on the appropriate surgical approach for patients with ST-II AEG. Embarked in November 2019, this research will be completed 3 years after the final participant’s enrolment date. Trial registration Clinical Trial.gov ID: NCT04910789 May 29, 2021. Name: S2AEG.

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“…Four studies (10,14,16,19) reported the operation time and showed that the TA approach took a shorter time, but the pooled analysis showed no difference between the TA and TT groups (MD = −54.61, 95% CI = −123.76 to 14.54, P = 0.12) (Figure 4A). Four studies (10,14,16,19) reported intraoperative blood loss and there was a trend that the TA approach was related to less intraoperative blood loss with no statistical difference…”

Section: Surgical Outcomesmentioning

confidence: 99%

“…They point out that the TT approach has the merits of complete resection of the upper bound of the tumor, sufficient dissection of mediastinal lymph nodes (LNs), and little difficulty in anastomosis (7)(8)(9). However, gastrointestinal surgeons consider the TA approach the better choice, and they argue that the TA approach has the advantages of complete dissection of abdominal LNs, mild surgical trauma, fewer postoperative complications, and is especially suitable for elderly patients who have poor cardiorespiratory function (7,10,11).…”

Section: Introductionmentioning

confidence: 99%

Comparison of Efficacy Between Transabdominal and Transthoracic Surgical Approaches for Siewert Type II Adenocarcinoma of the Esophagogastric Junction: A Systematic Review and Meta-Analysis

Jiang

Chen

et al. 2022

Front. Oncol.

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BackgroundThe optimal surgical approach, whether transabdominal (TA) or transthoracic (TT), for Siewert type II adenocarcinoma of the esophagogastric junction (AEG) remains controversial. This study compares the efficacy of TA and TT surgical approaches for Siewert type II AEG.MethodsStudies comparing the surgical and oncological outcomes of TA and TT surgical approaches for Siewert type II AEG up to June 2021 were systematically searched on the Web of Science, PubMed, Embase, and Cochrane Library. A pooled analysis was performed for the available data regarding the baseline features, surgical, and oncological outcomes. The RevMan 5.3 software was used to perform the statistical analysis. Quality evaluation and publication bias were also conducted.ResultsTwelve studies with a total of 2,011 patients, including 985 patients in the TA group and 1,026 patients in the TT group, were included in this study. In the pooled analysis, the surgical outcomes, namely, operative time (MD = −54.61, 95% CI = −123.76 to 14.54, P = 0.12), intraoperative blood loss (MD = −28.85, 95% CI = −71.15 to 13.46, P = 0.18), the number of dissected lymph nodes (MD = 1.90, 95% CI = −1.32 to 5.12, P = 0.25), postoperative complications (OR = 0.84, 95% CI = 0.65 to 1.07, p = 0.16), anastomotic leakage rate (OR = 1.02, 95% CI = 0.63 to 1.65, p = 0.93), and postoperative death rate (OR = 0.89, 95% CI = 0.46 to 1.72, p = 0.73), and the oncological outcomes, namely, overall recurrence rate (OR = 0.75, 95% CI = 0.37 to 1.50, p = 0.41), 3-year overall survival (OS) rate (OR = 1.19, 95% CI = 0.54 to 2.65, p = 0.66), and 5-year OS rate (OR = 1.21, 95% CI = 0.84 to 1.74, p = 0.30) of the two groups were all comparable.ConclusionsBoth TA and TT surgical approaches are appropriate for Siewert type II AEG, and neither has a significant advantage in terms of short- and long-term outcomes. However, more high-quality randomized controlled trials are needed to confirm this conclusion.

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<p>Short-Term and Long-Term Outcomes Following Transhiatal versus Right Thoracoabdominal Resection of Siewert Type II Adenocarcinoma of the Esophagogastric Junction</p>

Cited by 9 publications

References 31 publications

Transthoracic Approach vs Transhiatal-Abdominal Approach in the Treatment of Locally Advanced Siewert Type II Esophagogastric Junctional Adenocarcinoma: A Retrospective Study

Transthoracic Approach vs Transhiatal-Abdominal Approach in the Treatment of Locally Advanced Siewert Type II Esophagogastric Junctional Adenocarcinoma: A Retrospective Study

The abdominal-transhiatal surgical approach versus the thoracoabdominal surgical approach in Siewert type II adenocarcinoma of the esophagogastric junction: protocol for a multicenter prospective, open, parallel, and randomized controlled trial

Comparison of Efficacy Between Transabdominal and Transthoracic Surgical Approaches for Siewert Type II Adenocarcinoma of the Esophagogastric Junction: A Systematic Review and Meta-Analysis

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