Technical aspects and results of the transhiatal resection in adenocarcinomas of the gastroesophageal junction^*

Abstract

The distribution of lymph node metastases of adenocarcinomas of the gastroesophageal junction is classified into three types. The R0 resection with complete lymphadenectomy therefore requires different resection methods for type 1 and type 2/3 tumors. Comparing the subtotal esophagectomy and the extended gastrectomy, no advantage in survival can be seen for one method or one tumor type (type 1 or type 2/3). The same is true for the lethality. Indeed, the transhiatal resection is accompanied by a higher complication rate. However, the different operation methods for cardiacarcinomas, with subtotal esophagectomy in type 1 and extended gastrectomy in type 2/3 tumors, should be maintained because of increased rates of local recurrence that may be expected if all cardiacarcinoma types were treated using subtotal esophagectomy with gastric tube interposition. Therefore, we suggest a subtotal esophagectomy only in type 1 tumors. In type 2/3 tumors, an extended gastrectomy with resection of the distal esophagus, lymphadenectomy of the lower mediastinum, and D2 lymphadenectomy should be performed.

Evidence-based approach to the treatment of esophagogastric junction tumors

“…In addition, the surgical approach was not an independent predictor of overall survival[ 16 ]. These findings were supported by other authors[ 17 - 19 ]. Nevertheless, postoperative morbidity after an esophagectomy remains high[ 20 ].…”

Dorsal Track Control (DTC): A Modified Surgical Technique for Atraumatic Handling of the Distal Esophagus in Esophagojejunostomy

“…Numerous different approaches have been developed and evaluated to improve the technical simplicity and safety of laparoscopic approaches for esophagojejunostomy in gastrectomy and extended gastrectomy. However, despite of laparoscopic evolution and its increasing acceptance, an open extended gastrectomy is still preferred as the most applicable technical approach, and to date, is still considered as the gold standard [14], especially with the limited involvement of the distal segment of the esophagus [15]. Particularly for AEG II, the open approach remains the preferred technique, because the extent of resection cannot be determined safely prior to surgery [9].…”