Two Different Surgical Approaches in the Treatment of Adenocarcinoma at the Gastroesophageal Junction

Abstract

Provided that adequate tumor dissection is performed, patients with adenocarcinoma at the gastroesophageal junction can be resected and reconstructed using the principles for esophagectomy or extended gastrectomy.

Surgical strategies in true adenocarcinoma of the esophagogastric junction (AEG II): thoracoabdominal or abdominal approach?

“…All significant factors in multivariate analysis by forward analysis were confirmed by backward analysis c Cox regression, forward proportional hazard model complications especially seem more frequent [24]. We were unable to demonstrate a difference in perioperative morbidity and mortality between the two procedures, in line with results from other studies [37,38,40]. We included reconstruction with gastric tube as well as fundus rotation gastroplasty for TAE in this analysis.…”

“…Despite multiple studies [8,[35][36][37][38][39][40], the discussion is still ongoing whether the "true" carcinoma of the cardia should be resected in accordance to a carcinoma of the esophagus or stomach. Most of the studies are of a heterogeneous design, summarizing different surgical approaches under esophagectomy and gastrectomy and including not only AEG II but AEG I-III.…”

Gastric Tube Reconstruction Reduces Postoperative Gastroesophageal Reflux in Adenocarcinoma of Esophagogastric Junction

“…With data from 1 year of postoperative follow-up of this sample size, it is safe to speculate that the trend of fewer postoperative complications in the gastric tube group would occur with the increase of sample size and duration of postoperative follow-up. Moreover, the original low incidence of anastomotic leakage [4,29], the improvement of the anastomotic instrument, and technology might contribute to the zero incidence of anastomotic leakage in this study. There is no evidence to state that the gastric tube group has the advantage of decreasing anastomotic leakage, although it should have, theoretically, considering the decreased anastomotic tension.…”

“…Type II AEG labels the adenocarcinoma positioned from 1 cm above to 2 cm below the EGJ. Type III AEG lies from 2-5 cm below the EGJ [4]. It is not uncommon that type II and type III AEG are accompanied by abdominal lymph node metastasis [5].…”

Optimal Extent of Lymph Node Dissection for Siewert Type II Esophagogastric Junction Carcinoma

“…This result might basically provide an explanation for why the oncologic outcomes between extended esophagectomy and total gastrectomy are comparable. 6,16 Therefore, both esophagectomy with gastric tube reconstruction and gastrectomy with Roux-en-Y reconstruction seem to be valid procedures clinically. Furthermore, several series have shown equivalent survival benefit between total gastrecromy and proximal gastrectomy for proximal gastric cancer 17,18 ; however, proximal gastrectomy confers incomplete lymphadenectomy for the No.…”