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

• Published in: Gastric cancer : official journal of the International Gastric Cancer Association and the Japanese Gastric Cancer Association Vol. 21; no. 2; pp. 303 - 314
• Main Authors: Blank, Susanne, Schmidt, Thomas, Heger, Patrick, Strowitzki, Moritz J., Sisic, Leila, Heger, Ulrike, Nienhueser, Henrik, Haag, Georg Martin, Bruckner, Thomas, Mihaljevic, André L., Ott, Katja, Büchler, Markus W., Ulrich, Alexis
• Format: Journal Article
• Language: English
• Published: Tokyo Springer Japan 01-03-2018; Springer Nature B.V
• Subjects: Abdominal Surgery; Adenocarcinoma; Adenocarcinoma - mortality; Adenocarcinoma - surgery; Adult; Aged; Cancer Research; Esophageal cancer; Esophageal Neoplasms - mortality; Esophageal Neoplasms - surgery; Esophagectomy - methods; Esophagectomy - mortality; Esophagogastric Junction - surgery; Female; Gastrectomy; Gastrectomy - methods; Gastrectomy - mortality; Gastric cancer; Gastroenterology; Humans; Kaplan-Meier Estimate; Lymph nodes; Male; Medical prognosis; Medicine; Medicine & Public Health; Middle Aged; Morbidity; Mortality; Multivariate analysis; Oncology; Original Article; Proportional Hazards Models; Stomach Neoplasms - mortality; Stomach Neoplasms - surgery; Surgery; Surgical Oncology; Survival; Tumors; Thoracoabdominal esophagectomy; Transhiatal extended gastrectomy; AEG II; Ivor–Lewis operation; Adenocarcinoma of the cardia
• ISSN: 1436-3291; 1436-3305
• DOI: 10.1007/s10120-017-0746-1

Background
The optimal surgical approach for adenocarcinoma directly at the esophagogastric junction (AEG II) is still under debate. This study aims to evaluate the differences between right thoracoabdominal esophagectomy (TAE) (Ivor–Lewis operation) and transhiatal extended gastrectomy (THG) for AEG II.
Methods
From a prospective database, 242 patients with AEG II (TAE,
n
 = 56; THG,
n
 = 186) were included and analyzed according to characteristics and perioperative morbidity and mortality and overall survival (chi-square, Mann–Whitney
U
, log-rank, Cox regression).
Results
Groups were comparable at baseline with exception of age. Patients older than 70 years were more frequently resected by THG (
p
 = 0.003). No differences in perioperative morbidity (
p
 = 0.197) and mortality (
p
 = 0.711) were observed, including anastomotic leakages (
p
 = 0.625) and pulmonary complications (
p
 = 0.494). There was no significant difference in R0 resection (
p
 = 0.719) and number of resected lymph nodes (
p
 = 0.202). Overall median survival was 38.4 months. Survival after TAE was significantly longer than after THG (median OS not reached versus 33.6 months,
p
 = 0.02). Multivariate analysis revealed pN-category (
p
 < 0.001) and type of surgery (
p
 = 0.017) as independent prognostic factors. The type of surgery was confirmed as prognostic factor in locally advanced AEG II (cT 3/4 or cN1), but not in cT1/2 and cN0 patients.
Conclusions
Our single-center experience suggests that patients with (locally advanced) AEG II tumors may benefit from TAE compared to THG. For further evaluation, a randomized trial would be necessary.