transthoracic esophagectomy
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Author(s):  
Carlo Alberto De Pasqual ◽  
Pieter C van der Sluis ◽  
Jacopo Weindelmayer ◽  
Sjoerd M Lagarde ◽  
Simone Giacopuzzi ◽  
...  

Abstract Optimal surgical treatment for Siewert type II esophagogastric junction adenocarcinoma is debated. The aim of this study was to compare transhiatal extended gastrectomy (TEG) and transthoracic esophagectomy (TTE). Patients with Siewert type II tumors who underwent a resection by TEG or TTE in two centers (Erasmus University Medical Center, Rotterdam, and University of Verona) between 2014 and 2019 were identified. To limit selection bias, patients were matched for baseline characteristics and compared with a multivariable logistic regression model. Some 159 patients treated by TEG (60 patients, 37.7%) or TTE (99 patients, 62.3%) were included. Patients in the TEG group were older, had less tumor invasion of the esophagus, and were more often excluded from neoadjuvant therapy. Post-operative morbidity was comparable (P = 0.88), while 90-day mortality was higher after TEG (90-day mortality 10.0% in TEG group vs. 2.0% in TTE group P = 0.01). R0 resection was achieved in 83.3% of patients after TEG and in 97.9% after TTE (P < 0.01), with the proximal resection margin involved in 16.6% of patients after TEG versus 0 in TTE group (P < 0.01). The 3-year overall survival was comparable (TEG: 36.5%, TTE: 48.4%, P = 0.12). At multivariable analysis, (y)pT category was an independent risk factor for 3-year recurrence. After matching, TEG was still associated with an increased risk of incomplete tumor resection (P = 0.03) and proximal margin involvement (P < 0.01), while there were no differences in post-operative morbidity (P = 0.56) and mortality (P = 0.31). Our data suggest that patients with Siewert type II tumors treated by TEG are exposed to a higher risk of positive proximal resection margin compared to TTE.


Author(s):  
Amaia Gantxegi ◽  
B. Feike Kingma ◽  
Jelle P. Ruurda ◽  
Grard A. P. Nieuwenhuijzen ◽  
Misha D. P. Luyer ◽  
...  

Abstract Background The role of upper mediastinal lymphadenectomy for distal esophageal or gastroesophageal junction (GEJ) adenocarcinomas remains a matter of debate. This systematic review aims to provide a comprehensive overview of evidence on the incidence of nodal metastases in the upper mediastinum following transthoracic esophagectomy for distal esophageal or GEJ adenocarcinoma. Methods A literature search was performed using Medline, Embase and Cochrane databases up to November 2020 to include studies on patients who underwent transthoracic esophagectomy with upper mediastinal lymphadenectomy for distal esophageal and/or GEJ adenocarcinoma. The primary endpoint was the incidence of metastatic nodes in the upper mediastinum based on pathological examination. Secondary endpoints were the definition of upper mediastinal lymphadenectomy, recurrent laryngeal nerve (RLN) palsy rate and survival. Results A total of 17 studies were included and the sample sizes ranged from 10-634 patients. Overall, the median incidence of upper mediastinal lymph node metastases was 10.0% (IQR 4.7-16.7). The incidences of upper mediastinal lymph node metastases were 8.3% in the 7 studies that included patients undergoing primary resection (IQR 2.0-16.6), 4,4% in the 1 study that provided neoadjuvant therapy to the full cohort, and 10.6% in the 9 studies that included patients undergoing esophagectomy either with or without neoadjuvant therapy (IQR 8.9-15.8%). Data on survival and RLN palsy rates were scarce and inconclusive. Conclusions The incidence of upper mediastinal lymph node metastases in distal esophageal adenocarcinoma is up to 10%. Morbidity should be weighed against potential impact on survival.


2021 ◽  
Vol 34 (Supplement_1) ◽  
Author(s):  
Eliza Hagens ◽  
B Kingma ◽  
M Berge Henegouwen ◽  
A Borggreve ◽  
J Ruurda ◽  
...  

Abstract   Lymph node status in patients with esophageal carcinoma is one of the most important prognostic parameters in esophageal carcinoma. The distribution pattern of lymph node metastases and the optimal extent of lymphadenectomy remains unclear. Therefore the extent of high mediastinal lymphadenectomy, including removal of the paratracheal lymph node stations, in esophageal surgery is a subject of debate. The aim of this study is to investigate the impact of paratracheal lymphadenectomy on survival. Methods For this nation-wide population-based cohort study, patients with an esophageal or gastro-esophageal junction carcinoma treated by elective transthoracic esophagectomy with two-field lymphadenectomy between 2011 and 2017 were included from the national Dutch Upper Gastro-intestinal Cancer Audit (DUCA) registry. Patients who died within 30 days after surgery or where lymphadenectomy data was missing were excluded from analyses. After propensity score matching patients with adenocarcinoma and squamous cell separately, overall survival was compared between patients who underwent paratracheal lymphadenectomy versus patients who did not. Subgroup analysis was performed in patients with cN0 disease. Results 3143 patients were included in the DUCA. A total of 512 patients with adenocarcinoma (n = 256 vs. n = 256) and 157 patients with squamous cell carcinoma (n = 62 vs. n = 62) were matched. For both patients with adenocarcinoma and squamous cell carcinoma a paratracheal lymphadenectomy was not significantly associated with longer overall survival (11 versus 10 months, p = 0.209 and 12 versus 11 months, p = 0.206, figure 1). In subgroup analysis, including patients with a squamous cell carcinoma and cN0 disease, paratracheal lymphadenectomy was associated with longer survival (13 versus 9 months, p = 0.011). This was not seen in patients with adenocarcinoma (11 versus 9 months p = 0.263). Conclusion In both patients with an esophageal adenocarcinoma as squamous cell carcinoma, the addition of paratracheal lymphadenectomy during transthoracic esophagectomy was not significantly associated with longer survival. However, a significantly longer survival was seen in cN0 patients who underwent an additional paratracheal lymphadenectomy, therefore routine removal of paratracheal lymph nodes might still be beneficial. Further studies are warranted with larger subgroups to investigate the impact of an additional (routine) paratracheal lymphadenectomy on survival.


2021 ◽  
Vol 34 (Supplement_1) ◽  
Author(s):  
Johannes Zacherl ◽  
Wolfgang Radlspöck ◽  
Said Albinni ◽  
Cordula Höfle ◽  
Viktoria Kertesz ◽  
...  

Abstract   Transthoracic esophagectomy with 2-field-lymphadenectomy (LAD) is the state of the art treatment of resectable adenocarcinoma of the distal esophagus (Siewert-Stein AEG type I) and may be performed in AEG II cardia cancers. However, it remains unclear whether paratracheal LAD contributes to a survival benefit. In this study we collected data regarding lymph node involvement of paratracheal nodes. Methods From 2014 to 2019 consecutive patients were included in the prospective analysis. Patients underwent hybrid or open Ivor Lewis esophagectomy and 2-field LAD. Paratracheal tissue was removed from the right side of the trachea along the superior vena cava above the azygos vein up to the the upper thoracic aperture. Paratracheal lymph nodes were histologically evaluated separately from the nodes of other stations. Results Ninety-five consecutive patients (12 were female, mean age 67, sd 10, AEG I 84, AEG II 11) were included in the prospective observation study. Seventy-two and 5 patients preoperatively received chemotherapy or radiochemotherapy, respectively. All of them underwent transthoracic esophagectomy (Ivor Lewis 93, McKeown 2—because of coexisting ultralong segment Barrett esophagus). Overall the mean (sd) lymph node count was 37 (12). In the right paratracheal region we found a median of 6 lymph nodes (range;1–22). In 42 (44%) patients positive lymph nodes were recorded, but there was no case with right paratracheal node involvement. Conclusion In the present study paratracheal lymph node involvement was evaluated after transthoracic esophagecotmy with 2-field lymphadenectomy. Remarkably, despite a high proportion of overall lymphatic involvement we did not observe any paratracheal nodal metastasis. Larger studies may show whether paratracheal lyphmadenectomy is necessary during radical esophagectomy for AEG I and AEG II cancers.


2021 ◽  
Vol 41 (9) ◽  
pp. 4455-4462
Author(s):  
EISUKE BOOKA ◽  
HIROTOSHI KIKUCHI ◽  
RYOMA HANEDA ◽  
WATARU SONEDA ◽  
SANSHIRO KAWATA ◽  
...  

BMC Cancer ◽  
2021 ◽  
Vol 21 (1) ◽  
Author(s):  
Shuntaro Yoshimura ◽  
Kazuhiko Mori ◽  
Motonari Ri ◽  
Susumu Aikou ◽  
Koichi Yagi ◽  
...  

Abstract Background The present study aimed to assess the lower invasiveness of robot-assisted transmediastinal radical esophagectomy by prospectively comparing this procedure with transthoracic esophagectomy in terms of perioperative outcomes, serum cytokine levels, and respiratory function after surgery for esophageal cancer. Methods Patients who underwent a robot-assisted transmediastinal esophagectomy or transthoracic esophagectomy between April 2015 and March 2017 were included. The perioperative outcomes, preoperative and postoperative serum IL-6, IL-8, and IL-10 levels, and respiratory function measured preoperatively and at 6 months postoperatively were compared in patients with a robot-assisted transmediastinal esophagectomy and those with a transthoracic esophagectomy. Results Sixty patients with esophageal cancer were enrolled. The transmediastinal esophagectomy group had a significantly lower incidence of postoperative pneumonia (p = 0.002) and a significantly shorter postoperative hospital stay (p < 0.0002). The serum IL-6 levels on postoperative days 1, 3, 5, and 7 were significantly lower in the transmediastinal esophagectomy group (p = 0.005, 0.0007, 0.022, 0.020, respectively). In the latter group, the serum IL-8 level was significantly lower immediately after surgery and on postoperative day 1 (p = 0.003, 0.001, respectively) while the serum IL-10 level was significantly lower immediately after surgery (p = 0.041). The reduction in vital capacity, percent vital capacity, forced vital capacity, and forced expiratory volume at 1.0 s 6 months after surgery was significantly greater in the transthoracic esophagectomy group (p < 0.0001 for all four measurements). Conclusions Although further, large-scale studies are needed to confirm our findings, robot-assisted transmediastinal esophagectomy may confer short-term benefits in radical surgery for esophageal cancer. Trial registration This trial was registered in the UMIN Clinical Trial Registry (UMIN000017565 14/05/2015).


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