Optimal treatment for Siewert type II and III adenocarcinoma of the esophagogastric junction: A retrospective cohort study with long-term follow-up

Hosoda, Kei; Yamashita, Keishi; Moriya, Hiromitsu; Mieno, Hiroaki; Watanabe, Masahiko

doi:10.3748/wjg.v23.i15.2723

Cited by 18 publications

(17 citation statements)

References 30 publications

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“…The most frequent metastatic lymph nodes are the proximal gastric lymph nodes, nodes at the esophageal hiatus, lower mediastinum and suprapancreatic lymph nodes. 33 Regarding this results and regarding the patterns of recurrence, many authors share the opinion that an extensive mediastinal lymph node dissection is unnecessary. 17 , 32 , 33 , 34 It therefore seems reasonable that the mediastinal lymphadenectomy via thoraco-abdominal approach is not mandatory.…”

Section: Discussionmentioning

confidence: 87%

“…Many studies supported this approach for tumors types S II and S III. 17 , 23 , 32 , 33 , 34 Yamashita analyzed the pattern of lymph nodes involvement in patients of tumors extending in the region of the EGJ. They found that in gastric predominant EGJ tumors suprapancreatic lymph nodes had the highest metastases rate.…”

Section: Discussionmentioning

confidence: 99%

“…Similar results were obtained by other authors. 32 , 33 , 34 Moreover, the most prevalent site of lymph node recurrence was abdominal para-aortic. 17 This fact matches with the results of our study regarding the site of the recurrence.…”

Section: Discussionmentioning

confidence: 99%

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Outcomes of the surgical treatment for adenocarcinoma of the cardia – single institution experience

Potrč

Ivanecz

Krebs

et al. 2017

Radiology and Oncology

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BackgroundAdenocarcinomas at the cardia are biologically aggressive tumors with poor long-term survival following curative resection. For resectable adenocarcinoma of the cardia, mostly esophagus extended total gastrectomy or esophagus extended proximal gastric resection is performed; however, the surgical approach, transhiatal or transthoracic, is still under discussion. Postoperative morbidity, mortality and long-term survival were analyzed to evaluate the potential differences in clinically relevant outcomes.Patients and methodsOf altogether 844 gastrectomies performed between January 2000 and December 2016, 166 were done for the adenocarcinoma of the gastric cardia, which we analyzed with using the Cox proportional hazards model.Results136 were esophagus extended total gastrectomy and 125 esophagus extended proximal gastric resection. A D2 lymphadenectomy was performed in 88.2%, splenectomy in 47.2%, and multivisceral resections in 12.4% of patients. R0 resection rate was 95.7%. The mean proximal resection margin on the esophagus was 42.45 mm. It was less than 21 mm in 9 patients. Overall morbidity regarding Clavien-Dindo classification (> 1) was altogether 28.6%. 15.5% were noted as surgical and 21.1% as medical complications. The 30-day mortality was 2.2%. The 5-year survival for R0 resections was 33.4%. Multivisceral resection, depth of tumor infiltration, nodal stage, and curability of the resection were identified as independent prognostic factors.ConclusionsTranshiatal approach for resection of adenocarcinoma of the cardia is a safe procedure for patients with Siewert II and III regarding the postoperative morbidity and mortality; moreover, long-term survival is comparable to transthoracic approach. The complications associated with thoracoabdominal approach can therefore be avoided with no impact on the rate of local recurrence.

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Section: Discussionmentioning

confidence: 87%

Section: Discussionmentioning

confidence: 99%

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Outcomes of the surgical treatment for adenocarcinoma of the cardia – single institution experience

Potrč

Ivanecz

Krebs

et al. 2017

Radiology and Oncology

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“…To date, no standard proximal surgical margin exists for Siewert type II AEG. Hosoda et al [14] suggested that the lymph nodes of stations 1, 2, 3, and 7 can be dissected in Siewert type II and III AEG due to their high indexes of estimated benefit from lymph node dissection (IEBLDs). According to the report from Kurokawa et al [15], metastasis is associated with Siewert type II AEG ≥ 2 cm.…”

Section: Discussionmentioning

confidence: 99%

Total laparoscopic transabdominal-transdiaphragmatic approach for treating Siewert II tumors

Liu

Zhang

Huang

et al. 2020

Preprint

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Background: Although the morbidity of gastric cancer has decreased, the incidence of adenocarcinoma of the esophagogastric junction (AEG) is increasing. Furthermore, no consensus exists on which surgical approach should be applied for Siewert type II AEG. The purpose of our study was to evaluate the technical safety and feasibility of a new surgical approach.Methods: Sixty patients with Siewert type II AEG underwent laparoscopic total gastrectomy with the total laparoscopic transabdominal-transdiaphragmatic (TLTT) approach, which needs an incision in the diaphragm. Results: The median operative time, reconstruction time and estimated blood loss were 214.8±41.60 mins, 29.40±7.09 mins and 209.00±110.27 ml, respectively. All of the patients had negative surgical margins. Conclusion: There were no intraoperative complications or conversions to open surgery. Our surgical procedure provides a unique option for the safe application of laparoscopic lower mediastinal lymph node dissection and gastrointestinal reconstruction.

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“…In Asian countries, especially in China, most tumors in the esophagogastric junction are classified as Siewert type II and III, whereas in Western countries, type I is more prevalent . Surgical resection is still the main treatment option for patients with resectable AEG . For patients with Siewert type II AEG, because the tumor is located between the thoracic and abdominal cavities, cancer cells can metastasize to the abdominal or mediastinal lymph nodes through the lymphatic system.…”

Section: Introductionmentioning

confidence: 99%

Comparison of short‐term outcomes following minimally invasive versus open Sweet esophagectomy for Siewert type II adenocarcinoma of the esophagogastric junction

et al. 2020

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Background: Surgical resection is still the main treatment option for patients with resectable Siewert type II adenocarcinoma of the esophagogastric junction (AEG). This retrospective study evaluated the significance of minimally invasive Sweet esophagectomy (MISE) for the treatment of Siewert type II AEG. Methods: We retrospectively evaluated 174 patients with Siewert type II AEG who received a Sweet esophagectomy in our center between October 2013 and September 2017. Of these patients, 73 underwent MISE and 101 underwent open Sweet esophagectomy (OSE). The clinicopathologic factors, operational factors and postoperative complications were compared. Results: The two groups were similar in terms of age, sex, American Society of Anesthesiologists grade, preoperative staging and incidence of comorbidities (P > 0.05). Relative to the OSE approach, the MISE approach was associated with a significant decrease in surgical blood loss (P < 0.001), chest tube duration (P = 0.003) and postoperative admission duration (P = 0.002). The minimally invasive approach was associated with significantly less total morbidity and fewer respiratory complications than the open approach (P = 0.015 and P = 0.016, respectively). Relative to the open approach, the MISE approach was associated with a significant increase in the number of total lymph nodes removed and the locations of the total lymph nodes removed (P < 0.001 and P < 0.001, respectively). Conclusions: Our MISE technique can be safely and effectively performed for intrathoracic anastomosis with favorable early outcomes.

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Optimal treatment for Siewert type II and III adenocarcinoma of the esophagogastric junction: A retrospective cohort study with long-term follow-up

Cited by 18 publications

References 30 publications

Outcomes of the surgical treatment for adenocarcinoma of the cardia – single institution experience

Outcomes of the surgical treatment for adenocarcinoma of the cardia – single institution experience

Total laparoscopic transabdominal-transdiaphragmatic approach for treating Siewert II tumors

Comparison of short‐term outcomes following minimally invasive versus open Sweet esophagectomy for Siewert type II adenocarcinoma of the esophagogastric junction

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