Surgical approach for Siewert type II adenocarcinoma of the esophagogastric junction: transthoracic or transabdominal? —a single-center retrospective study

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

Disease Markers ◽

10.1155/2019/9637972 ◽

2019 ◽

Vol 2019 ◽

pp. 1-11 ◽

Cited By ~ 2

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.

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

Journal of International Medical Research ◽

10.1177/0300060518802923 ◽

2018 ◽

Vol 47 (1) ◽

pp. 398-410 ◽

Cited By ~ 2

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.

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

World Journal of Surgical Oncology ◽

10.1186/s12957-021-02136-2 ◽

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.

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