scholarly journals Total laparoscopic transabdominal-transdiaphragmatic approach for treating Siewert II tumors: a prospective analysis of a case series

2021 ◽  
Vol 19 (1) ◽  
Author(s):  
Wei Pang ◽  
Gang Liu ◽  
Yan Zhang ◽  
Yun Huang ◽  
Xinpu Yuan ◽  
...  
Keyword(s):  
Surgical Approach ◽  
Mediastinal Lymph Node ◽  
Intraoperative Complications ◽  
Case Series ◽  
Type Ii ◽  
Clinical Trial Registry ◽  
Siewert Type ◽  
Siewert Type Ii ◽  
Estimated Blood Loss ◽  
Gastrointestinal Reconstruction

Abstract 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 ± 41.6 min, 29.40 ± 7.1 min, and 209.0 ± 110.3 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. Trial registration Chinese Clinical Trial Registry, ChiCTR1800014336. Registered on 31 December 2017 - Prospectively registered, http://www.chictr.org.cn/edit.aspx?pid=23111&htm=4.

scholarly journals Total laparoscopic transabdominal-transdiaphragmatic approach for treating Siewert II tumors

2020 ◽  
Author(s):  
Wei Pang ◽  
Gang Liu ◽  
Yan Zhang ◽  
Yun Huang ◽  
Xinpu Yuan ◽  
...  
Keyword(s):  
Surgical Approach ◽  
Mediastinal Lymph Node ◽  
Intraoperative Complications ◽  
Type Ii ◽  
Clinical Trial Registry ◽  
Siewert Type ◽  
Siewert Type Ii ◽  
Estimated Blood Loss ◽  
Gastrointestinal Reconstruction ◽  
Reconstruction Time

Abstract 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. Trial Registration: Chinese Clinical Trial Registry, ChiCTR1800014336. Registered 31 December 2017- Prospectively registered, http://www.chictr.org.cn/edit.aspx?pid=23111&htm=4.

scholarly journals Total laparoscopic transabdominal-transdiaphragmatic approach for treating Siewert II tumors

2020 ◽  
Author(s):  
Wei Pang ◽  
Gang Liu ◽  
Yan Zhang ◽  
Yun Huang ◽  
Xinpu Yuan ◽  
...  
Keyword(s):  
Surgical Approach ◽  
Mediastinal Lymph Node ◽  
Intraoperative Complications ◽  
Type Ii ◽  
Clinical Trial Registry ◽  
Siewert Type ◽  
Siewert Type Ii ◽  
Estimated Blood Loss ◽  
Gastrointestinal Reconstruction ◽  
Reconstruction Time

Abstract BackgroundAlthough 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.MethodsSixty 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.ResultsThe median operative time, reconstruction time and estimated blood loss were 214.8±41.6 mins, 29.40±7.1 mins and 209.0±110.3 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. Trial RegistrationChinese Clinical Trial Registry, ChiCTR1800014336. Registered 31 December 2017- Prospectively registered, http://www.chictr.org.cn/edit.aspx?pid=23111&htm=4.

scholarly journals Proximal Gastrectomy versus Total Gastrectomy for Siewert Type II Adenocarcinoma of the Esophagogastric Junction: A Comprehensive Analysis of Data from the SEER Registry

2019 ◽  
Vol 2019 ◽  
pp. 1-11 ◽  
Author(s):  
Kaixuan Zhu ◽  
Yingying Xu ◽  
Jiaxin Fu ◽  
Farah Abdidahir Mohamud ◽  
Zongkui Duan ◽  
...  
Keyword(s):  
Total Gastrectomy ◽  
Surgical Approach ◽  
Esophagogastric Junction ◽  
Proximal Gastrectomy ◽  
Locally Advanced ◽  
Cox Proportional Hazards Model ◽  
Type Ii ◽  
Siewert Type ◽  
Siewert Type Ii ◽  
Significant Difference

Background. To determine the ideal surgical approach (total gastrectomy (TG) vs. proximal gastrectomy (PG)) for Siewert type II adenocarcinoma of the esophagogastric junction (AEG), we searched and analyzed the Surveillance, Epidemiology, and End Results (SEER) data. Methods. Patients with Siewert type II AEG treated by TG or PG were identified from the 2004–2014 SEER dataset. We obtained the patients’ overall survival (OS) and cancer-specific survival (CSS) and stratified the patients by surgical approach. We performed a propensity score 1 : 1 matching (PSM) analysis and a univariate and multivariate Cox proportional hazards model. Results. A total of 2,217 patients with 6th AJCC stage IA–IIIB Siewert type II AEG was examined: 1,584 patients (71.4%) underwent PG, and 633 patients (28.6%) underwent TG. The follow-up time was 1–131 months. OS favored total gastrectomy before the PSM analysis (χ2=3.952, p=0.047), but after this analysis, there was no significant difference between TG and PG (χ2=2.227, p=0.136). The univariate and multivariate analyses identified age as an independent factor, and an X-tail analysis revealed 70 years as a cut-off point. The patients aged≥70 years obtained a significant long-term OS benefit from PG compared to TG (χ2=8.245, p=0.004), and those aged<70 years showed no difference between TG and PG (χ2=0.167, p=0.682). Conclusions. PG showed an equivalent survival benefit to TG in both the early and locally advanced stages of Siewert type II AEG. For elderly patients, PG is strongly recommended because of its clearer OS benefit compared to TG.

scholarly journals Novel abdominal approach for dissection of advanced type II/III adenocarcinoma of the esophagogastric junction: a new surgical option

2018 ◽  
Vol 47 (1) ◽  
pp. 398-410 ◽  
Author(s):  
Can Hu ◽  
Hao-te Zhu ◽  
Zhi-yuan Xu ◽  
Jian-fa Yu ◽  
Yi-an Du ◽  
...  
Keyword(s):  
Lymph Node ◽  
Survival Rate ◽  
Postoperative Complications ◽  
Total Gastrectomy ◽  
Surgical Approach ◽  
Esophagogastric Junction ◽  
Abdominal Cavity ◽  
Type Ii ◽  
Siewert Type ◽  
Siewert Type Ii

Objective The optimal surgical approach for Siewert type II adenocarcinoma of the esophagogastric junction (AEG) is controversial. In this study, we evaluated the outcomes of total gastrectomy for Siewert type II/III AEG via the left thoracic surgical approach that is used at our center. Methods We identified 41 patients with advanced AEG in our retrospective database and analyzed their 3-year survival rate, upper surgical margin, postoperative complications, and index of estimated benefit from lymph node dissection. Results The 3-year overall survival rate of the whole group was 63%, but no difference was observed between Siewert type II and III AEGs. Esophageal exposure and lymphadenectomy were sufficient. Eight patients developed postoperative complications, but none of the patients developed anastomotic leakage. Dissection of lymph node station Nos. 19 and 110 may be necessary for patients with Siewert type II AEG. Multivariate analysis revealed that the cT category was the only independent risk factor. Conclusions Total gastrectomy via an approach from the abdominal cavity into the thoracic cavity may be an optimal surgical technique for advanced Siewert type II AEG.

FA05.04: CLINICAL SIGNIFICANCE OF ESOPHAGEAL INVASION LENGTH FOR THE PREDICTION OF MEDIASTINAL LYMPH NODE METASTASIS IN SIEWERT TYPE II ADENOCARCINOMA

2018 ◽  
Vol 31 (Supplement_1) ◽  
pp. 10-11
Author(s):  
Kazuo Koyanagi ◽  
Fumihiko Kato ◽  
Jun Kanamori ◽  
Hiroyuki Daiko ◽  
Yuji Tachimori ◽  
...  
Keyword(s):  
Lymph Node ◽  
Lymph Node Metastasis ◽  
Mediastinal Lymph Node ◽  
Esophageal Wall ◽  
Type Ii ◽  
Mediastinal Lymph Node Metastasis ◽  
Siewert Type ◽  
Siewert Type Ii ◽  
Node Metastasis ◽  
Esophageal Invasion

Abstract Background We focused on the esophageal invasion length (EIL), defined as the distance from the EGJ to the proximal edge, of Siewert type II adenocarcinomas. This study investigated whether the EIL could be a possible indicator of mediastinal lymph node metastasis and survival in the Siewert type II patients. Methods The 168 consecutive patients with Siewert type II tumor who underwent surgery were enrolled. Metastatic stations and recurrent lymph node sites were classified into cervical, upper/middle/lower mediastinal, and abdominal zones. EIL was correlated with overall metastasis or recurrence in individual zones and survival. Results The ROC curve for EIL was generated to predict the rates of upper and middle mediastinal lymph node metastasis or recurrence, and the cut-off EIL value was determined to be 25 mm with an area under the curve of 0.83 (sensitivity, 80.8%; specificity, 72.3%). Siewert type II patients with an EIL of more than 25 mm (> 25 mm EIL group) had a higher incidence of overall metastasis or recurrence in the upper and middle mediastinal zones than those with an EIL of less than or equal to 25 mm (≤ 25 mm EIL group) (P = 0.001 and P < 0.001). Disease free and overall survival in the > 25 mm EIL group were significantly lower than those of the ≤ 25 mm EIL group (P < 0.001). None of the Siewert type II patients with metastasis or recurrence in the upper and middle mediastinal zones survived for more than five years. On the other hand, the efficacy index of the lower mediastinal lymph node and the abdominal lymph node were 5.6 and 21.7, respectively. Only EIL of more than 25 mm was a significant preoperative predictor of overall metastasis or recurrence in the upper and middle mediastinal zone (odds ratio, 8.85; 95% CI, 2.31−33.3; P = 0.001). Conclusion An EIL of more than 25 mm might be a preoperative predictor of overall metastasis or recurrence in the upper and middle mediastinal zones. A multimodal-therapeutic strategy should be investigated in Siewert type II patients once the tumor has invaded to the esophageal wall more than 25 mm. Disclosure All authors have declared no conflicts of interest.

Lower Mediastinal Lymph Node Metastasis is an Independent Survival Factor of Siewert Type II and III Adenocarcinomas in the Gastroesophageal Junction

2012 ◽  
Vol 78 (5) ◽  
pp. 567-573 ◽  
Author(s):  
Masaki Nakamura ◽  
Makoto Iwahashi ◽  
Mikihito Nakamori ◽  
Teiji Naka ◽  
Toshiyasu Ojima ◽  
...  
Keyword(s):  
Lymph Node ◽  
Lymph Node Metastasis ◽  
Mediastinal Lymph Node ◽  
Type Ii ◽  
Mediastinal Lymph Node Metastasis ◽  
Siewert Type ◽  
Survival Factors ◽  
Siewert Type Ii ◽  
Type Iii ◽  
Node Metastasis

We examined clinicopathological features and surgical outcomes in patients with adenocarcinoma in the gastroesophageal junction (GEJ), while also analyzing the survival factors that have a prognostic impact. Between 1991 and 2009, 61 patients with tumors in the GEJ (Siewert type II and III) underwent primary surgical resection. Thirty of 61 patients had type II tumors (49.2%) and 31 had type III tumors (50.8%). The tumor size was larger in type III tumors than type II tumors ( P = 0.0026). The overall 5-year survival rates in patients with type II tumors and type III tumors were 44.2 per cent and 41.4 per cent, respectively, with no significant differences ( P = 0.1888). The independent survival factors were lower mediastinal lymph node metastasis ( P = 0.0323) and a noncurative resection ( P = 0.0442). The independent survival factors for patients who underwent curative resections were the tumor size ( P = 0.0422), M category ( P = 0.0489), and lower mediastinal lymph node metastasis ( P = 0.0482). This study showed lower mediastinal lymph node metastasis to be an independent survival factor, and also suggested that lower mediastinal lymph node metastasis was associated with distant metastasis in patients with adenocarcinoma in the GEJ (Siewert type II and III). Therefore, the preoperative early detection of such metastasis is important to improve patient survival.

Surgical approach for Siewert type II adenocarcinoma of the esophagogastric junction: transthoracic or transabdominal? A retrospective analysis in a single center

2018 ◽  
pp. 1-6
Keyword(s):  
Gastric Cancer ◽  
Survival Rate ◽  
Hospital Stay ◽  
Surgical Approach ◽  
Esophagogastric Junction ◽  
Type Ii ◽  
Single Center ◽  
Siewert Type ◽  
Siewert Type Ii ◽  
Shorten Hospital Stay

Background: Adenocarcinoma of the esophagogastric junction (AEG) is a special type of challenging carcinoma between esophageal and gastric cancer with controversy in the diagnosis, treatment and prognosis. The Siewert classification is widely accepted by the majority of scholars at home and abroad, in which, type I and type III AEG are usually treated based on the guidelines for esophageal cancer and gastric cancer, respectively. However, the surgical approach topatients with type II AEG still remains controversial. In this study, we intended to realize the different surgical approach for Siewert type II AEG treatment by analyzing the data retrospectively. Methods: Patients with Siewert type II AEG were collected in Guangdong General Hospital from 2004 to 2014. We compared the clinicopathological outcome and prognosis in transthoracic(TT) and transabdominal(TA) approach. Results: A total of 158 patients with Siewert type II AEG were enrolled. Overall medium survival was 52 months and the 5-year survival rate was 39.1%. The 5-year survival rate was comparable between TT and TA group (35.1% vs 43.2%,p>0.05), while more lymph nodes were dissected in TA group (23.7±0.2 vs 18.1±0.3, p<0.05), with less postoperative complications (14.3%vs28.4%,p<0.05) and shorten hospital stay(12±4 d vs 15±7 d, p<0.05). Conclusion: For Siewert type II AEG patients, there is no significant difference in survival outcome as treated with TT or TA approach. However, fewer lymph nodes dissection number was conducted in transthoracic group, with a higher incidence of postoperative complication. Therefore, we consider that transabdominal approach is more suitable for patients with Siewert type II AEG to achieve an optimal extent of lymph node dissection, and reduce the incidence of complication, shorten hospital stay and promote the recovery. But our study is only a single-center, retrospective, small sample clinical study that represents our previous clinical treatment experience and we need more multi-center, prospective, and a large sample of clinical studies to be validated.

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