Thoracoabdominal versus transhiatal surgical approaches for adenocarcinoma of the esophagogastric junction—a systematic review and meta-analysis

Heger, Patrick; Blank, Susanne; Gooßen, Käthe; Nienhüser, Henrik; Ulrich, Alexis; Mihaljevic, André L.; Schmidt, Thomas

doi:10.1007/s00423-018-1745-3

Cited by 36 publications

(26 citation statements)

References 35 publications

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“…Regarding lymph node disease, Eastern studies have demonstrated that lymph node metastases among these tumors are frequently found in paracardic nodes, in the lesser curvature nodes, and in the left gastric artery nodes, which can be dissected both in an esophagectomy and in a gastrectomy 23 . Finally, a recent systematic review has failed to identify any difference in R0 resections, lymph node dissections, anastomotic leakage, and mortality, when the two procedures were compared; this same study identified higher postoperative morbidity after esophagectomies though 25 . In conclusion, the decision must be individualized and made according to the growth behavior of the tumor (proximal or distal) and the probability of lymph node dissemination (chest or abdomen).…”

Section: Commentsmentioning

confidence: 96%

Brazilian Gastric Cancer Association Guidelines (Part 2): Update on Treatment

Barchi¹,

Ramos²,

Dias³

et al. 2021

ABCD, arq. bras. cir. dig.

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Background : The II Brazilian Consensus on Gastric Cancer of the Brazilian Gastric Cancer Association BGCA (Part 1) was recently published. On this occasion, countless specialists working in the treatment of this disease expressed their opinion in the face of the statements presented. Aim : To present the BGCA Guidelines (Part 2) regarding indications for surgical treatment, operative techniques, extension of resection and multimodal treatment. Methods: To formulate these guidelines, the authors carried out an extensive and current review regarding each declaration present in the II Consensus, using the Medline/PubMed, Cochrane Library and SciELO databases initially with the following descriptors: gastric cancer, gastrectomy, lymphadenectomy, multimodal treatment. In addition, each statement was classified according to the level of evidence and degree of recommendation. Results : Of the 43 statements present in this study, 11 (25,6%) were classified with level of evidence A, 20 (46,5%) B and 12 (27,9%) C. Regarding the degree of recommendation, 18 (41,9%) statements obtained grade of recommendation 1, 14 (32,6%) 2a, 10 (23,3%) 2b e one (2,3%) 3. Conclusion : The guidelines complement of the guidelines presented here allows surgeons and oncologists who work to combat gastric cancer to offer the best possible treatment, according to the local conditions available.

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Section: Commentsmentioning

confidence: 96%

Brazilian Gastric Cancer Association Guidelines (Part 2): Update on Treatment

Barchi¹,

Ramos²,

Dias³

et al. 2021

ABCD, arq. bras. cir. dig.

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“…About half of the people with cancer of the esophagus or the gastroesophageal junction have metastatic disease at diagnosis, and there are few effective options after the progression of second-line chemotherapy [5,6]. Thus, surgery with or without adjuvant or neoadjuvant therapy is the treatment of choice for resectable cases with curative intent [7]. However, in inoperable cases, the conduit to be held is isolated chemotherapy or combined neoadjuvant chemotherapy associated with radiotherapy and is based on Cisplatin, Fluorouracil, Docetaxel, Epirubicin, Irinotecan, Fluoretaacin, Methotrexate, Epirubicin, and Capecitabine [8].…”

Section: Introductionmentioning

confidence: 99%

Durable and Effectiveness of Immunotherapy in the Treatment of Metastatic Gastroesophageal Junction Cancer

Moreira¹,

Bittencourt²,

Nogueira³

et al. 2020

Int J Immunol Immunother

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“…The ongoing CARDIA RCT may help to provide high-quality evidence for Siewert 2 tumors. Second, two published systematic reviews 13,14 reported comparable 5-year survival rates between esophagectomy (30-42 %) and gastrectomy (18-38 %) for GEJ, with acceptable rates for R0 resections and lymph node harvest.…”

Section: Discussionmentioning

confidence: 98%

Esophagectomy or Total Gastrectomy for Siewert 2 Gastroesophageal Junction (GEJ) Adenocarcinoma? A Registry-Based Analysis

et al. 2021

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Backgrounds Due to a lack of randomized and large studies, the optimal surgical approach for Siewert 2 gastroesophageal junctional (GEJ) adenocarcinoma remains unknown. This population-based cohort study aimed to compare survival between esophagectomy and total gastrectomy for the treatment of Siewert 2 GEJ adenocarcinoma. Methods Data from the National Cancer Database (NCDB) from 2010 to 2016 was used to identify patients with non-metastatic Siewert 2 GEJ adenocarcinoma who received either esophagectomy (n = 999) or total gastrectomy (n = 8595). Propensity score-matching (PSM) and multivariable analyses were used to account for treatment selection bias. Results Comparison of the unmatched cohort’s baseline demographics showed that the patients who received esophagectomy were younger, had a lower burden of medical comorbidities, and had fewer clinical positive lymph nodes. The patients in the unmatched cohort who received gastrectomy had a significantly shorter overall survival than those who received esophagectomy (median, 47 vs. 68 months [p < 0.001]; 5-year survival, 45 % vs. 53 %). After matching, gastrectomy was associated with significantly reduced survival compared with esophagectomy (median, 51 vs. 68 months [p < 0.001]; 5-year survival, 47 % vs. 53 %), which remained in the adjusted analyses (hazard ratio [HR], 1.22; 95 % confidence interval [CI], 1.09–1.35; p < 0.001). Conclusions In this large-scale population study with propensity-matching to adjust for confounders, esophagectomy was prognostically superior to gastrectomy for the treatment of Siewert 2 GEJ adenocarcinoma despite comparable lymph node harvest, length of stay, and 90-day mortality. Adequately powered randomized controlled trials with robust surgical quality assurance are the next step in evaluating the prognostic outcomes of these surgical strategies for GEJ cancer.

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Thoracoabdominal versus transhiatal surgical approaches for adenocarcinoma of the esophagogastric junction—a systematic review and meta-analysis

Cited by 36 publications

References 35 publications

Brazilian Gastric Cancer Association Guidelines (Part 2): Update on Treatment

Brazilian Gastric Cancer Association Guidelines (Part 2): Update on Treatment

Durable and Effectiveness of Immunotherapy in the Treatment of Metastatic Gastroesophageal Junction Cancer

Esophagectomy or Total Gastrectomy for Siewert 2 Gastroesophageal Junction (GEJ) Adenocarcinoma? A Registry-Based Analysis

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