Postoperative complications after a transthoracic esophagectomy or a transhiatal gastrectomy in patients with esophagogastric junctional cancers: a prospective nationwide multicenter study

Abstract

Background Esophagogastric junction (EGJ) cancers are resected thorough esophagectomy or gastrectomy, with the incidence of postoperative complications influenced by the chosen procedure. Methods In this prospective nationwide multicenter study, patients with cT2-T4 EGJ cancers were enrolled before surgery. Based on the protocol, surgeons performed a transthoracic esophagectomy (TTE) or a transhiatal gastrectomy (THG) and dissected all lymph nodes prespecified as the standardized procedure. Postoperative complications were correlated with the clinical factors in each procedure. Results A total of 345 patients were eligible for this study. TTE and THG were performed in 120 and 225 patients, respectively. Complications of Clavien-Dindo ≥ Grade II were found in 115/345 (33.3%) patients. Recurrent laryngeal nerve palsy was found only in the TTE group (p < 0.001). The incidence of other complications was not significantly different between the two groups. High body mass index (BMI) in the TTE group, male sex, and longer esophageal invasion in the THG group were significantly correlated with complications ≥ Grade II (p = 0.049, 0.037, and 0.019, respectively). Anastomotic leakage was most frequently observed (12.2%). Tumor size in the THG group (p = 0.02) was significantly associated with leakage. All six patients with ≥ Grade IV leakage underwent THG, whereas, none of the patients in the TTE group had leakage ≥ Grade IV (2.7% vs. 0%, p = 0.096). Conclusions Surgical resection should be performed with utmost care, particularly in patients with a high BMI undergoing TTE, and in patients with larger tumors, longer esophageal invasion, or male patients undergoing THG.

Whether the infracardiac bursa protect right pleura during laparoscopic radical operation of Siewert type II adenocarcinoma of esophagogastric junction?

“…It is report that the rate of operative complications was 29.2% in an esophagectomy via a transthoracic approach and 27.6% in a gastrectomy via a transhiatal approach [24]. However, in our study, the rate of operative complications was only 3.1% in exposed group and 11.1% in unexposed group.…”

Essential updates 2021/2022: Perioperative and surgical treatments for gastric and esophagogastric junction cancer

“…However, laparoscopic procedures such as anastomosis are far more technically demanding for EGJC than for GC. A Japanese multicenter prospective study demonstrated that the laparoscopic transhiatal approach led to a relatively high incidence of anastomotic leakage, at 19.0% 55 . Unlike for GC, this approach is not yet standardized for EGJC, and it is performed only by experts at a few high‐volume centers.…”

The role of proximal gastrectomy in gastric cancer

“…DFT has advantages over direct EG reconstruction, such as physiologic alignment by which all food intake flows through the duodenum, but DFT is technically challenging, particularly when performed at a high level within the mediastinum by laparoscopic approach. In addition, the remnant stomach is disconnected from the vagus nerve distribution, thus leading to the risk of delayed gastric emptying (43,45,46).…”