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- Title
Surgical strategies in true adenocarcinoma of the esophagogastric junction (AEG II): thoracoabdominal or abdominal approach?
- 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
- 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.
- Subjects
ADENOCARCINOMA; GASTRECTOMY; PULMONARY alveoli; ONCOLOGIC surgery; GASTRIC diseases
- Publication
Gastric Cancer, 2018, Vol 21, Issue 2, p303
- ISSN
1436-3291
- Publication type
Article
- DOI
10.1007/s10120-017-0746-1