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


Ontology type: schema:ScholarlyArticle      Open Access: True


Article Info

DATE

2018-03

AUTHORS

Susanne Blank, Thomas Schmidt, Patrick Heger, Moritz J. Strowitzki, Leila Sisic, Ulrike Heger, Henrik Nienhueser, Georg Martin Haag, Thomas Bruckner, André L. Mihaljevic, Katja Ott, Markus W. Büchler, Alexis Ulrich

ABSTRACT

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. More... »

PAGES

303-314

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  • Identifiers

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    http://scigraph.springernature.com/pub.10.1007/s10120-017-0746-1

    DOI

    http://dx.doi.org/10.1007/s10120-017-0746-1

    DIMENSIONS

    https://app.dimensions.ai/details/publication/pub.1090371832

    PUBMED

    https://www.ncbi.nlm.nih.gov/pubmed/28685209


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