Short-term efficacy analysis of different surgical methods for Siewert type Ⅰ and Ⅱ esophagogastric junction carcinoma_Chinese Journal of Clinical Thoracic and Cardiovascular Surgery

Authors：

 JIA Zhuoqi ¹ , ZHOU Weiru ² , LI Shuo ¹ , CHEN Nanzheng ¹ , LI Haijun ¹ , ZHANG Guangjian ¹ , FU Junke ¹ ,  ZHANG Yong ¹

1. Department of Thoracic Surgery, First Affiliated Hospital of Xi’an Jiaotong University, Xi’an, 710061, P.R.China;
2. Department of Nuclear Medicine, Xi’an Gaoxin Hospital, Xi’an, 710075, P.R.China;

Corresponding author：

JIA Zhuoqi, Email: gosnow@163.com; ZHANG Yong, Email: zhangyongyang05@163.com

Keywords：

Esophagogastric junction carcinoma; adenocarcinoma of esophagogastric junction; gastric tube; jejunostomy

DOI：

10.7507/1007-4848.201909010

Video：

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Objective To compare and analyze the short-term efficacy of different surgical methods for Siewert type Ⅰ and type Ⅱ esophagogastric junction carcinoma.Methods We selected 82 patients who accepted radical resection of esophagogastric junction carcinoma from March 2015 to March 2018 in our department, including 53 males and 29 females, aged 48-72 (61±6) years. The patients were divided into four groups according to the surgical method: a left thoracotomy group (n=14), a laparoscopic left small thoracotomy group (n=33), a thoracoscopic Ivor-Lewis group (n=17), and a thoracoscopic McKeown group (n=18). Their clinical characteristics, operative situations, postoperative complications and survival rate were analyzed.Results Among the four groups, the left thoracotomy group cost the shortest operation time, followed by laparoscopic left small thoracotomy group, thoracoscopic McKeown group and thoracoscopic Ivor-Lewis group. The thoracoscopic McKeown group/laparoscopic left small thoracotomy group had the least bleeding. The fewest lymph nodes were dissected in the left thoracotomy group and the most in the thoracoscopic McKeown group. The laparoscopic left small thoracotomy group had the lowest total complication rate and the incidence of pneumonia and arrhythmia among the four groups (P<0.05). There was no significant difference in survival rate among the four groups (P>0.05).Conclusion For Siewert type Ⅰ and type Ⅱ esophagogastric junction carcinoma, thoracoscopy combined with laparoscopic radical resection is safe and reliable. Laparoscopic left small thoracotomy has the advantages of minimal invasiveness and complete lymph node dissection, especially for the patients with poor cardiopulmonary function, which will significantly shorten operation time and reduce postoperative complications, so it is worth to be popularized.

Citation： JIA Zhuoqi, ZHOU Weiru, LI Shuo, CHEN Nanzheng, LI Haijun, ZHANG Guangjian, FU Junke, ZHANG Yong. Short-term efficacy analysis of different surgical methods for Siewert type Ⅰ and Ⅱ esophagogastric junction carcinoma. Chinese Journal of Clinical Thoracic and Cardiovascular Surgery, 2020, 27(4): 431-435. doi: 10.7507/1007-4848.201909010 Copy

1.	Siewert JR, Feith M, Stein HJ. Biologic and clinical variations of adenocarcinoma at the esophago-gastric junction: relevance of a topographic-anatomic subclassification. J Surg Oncol, 2005, 90(3): 139-146.
2.	Matsuno K, Ishihara R, Ohmori M, et al. Time trends in the incidence of esophageal adenocarcinoma, gastric adenocarcinoma, and superficial esophagogastric junction adenocarcinoma. J Gastroenterol, 2019, 54(9): 784-791.
3.	Matsueda K, Manabe N, Toshikuni N, et al. Clinical characteristics and associated factors of Japanese patients with adenocarcinoma of the esophagogastric junction: a multicenter clinicoepidemiological study. Dis Esophagus, 2017, 30(6): 1-6.
4.	Giacopuzzi S, Bencivenga M, Weindelmayer J, et al. Western strategy for EGJ carcinoma. Gastric Cancer, 2017, 20(Suppl 1): 60-68.
5.	Huang CM, Lv CB, Lin JX, et al. Laparoscopic-assisted versus open total gastrectomy for Siewert type Ⅱ and Ⅲ esophagogastric junction carcinoma: a propensity score-matched case-control study. Surg Endosc, 2017, 31(9): 3495-3503.
6.	Blank S, Schmidt T, Heger P, et al. Surgical strategies in true adenocarcinoma of the esophagogastric junction (AEG Ⅱ): thoracoabdominal or abdominal approach? Gastric Cancer, 2018, 21(2): 303-314.
7.	Hosoda K, Yamashita K, Moriya H, et al. Optimal treatment for Siewert type Ⅱ and Ⅲ adenocarcinoma of the esophagogastric junction: a retrospective cohort study with long-term follow-up. World J Gastroenterol, 2017, 23(15): 2723-2730.
8.	蔡杰, 彭俊, 王文凭, 等. SiewertⅡ型食管胃结合部腺癌淋巴结转移规律及手术方式的选择. 中国胸心血管外科临床杂志, 2016, 23(2): 151-155.
9.	国际食管疾病学会中国分会(CSDE)食管胃结合部疾病跨界联盟, 中国医师协会内镜医师分会腹腔镜外科专业委员会, 中国医师协会外科医师分会上消化道外科医师专业委员会, 等. 食管胃结合部腺癌外科治疗中国专家共识(2018 年版). 中华胃肠外科杂志, 2018, 21(9): 961-975.
10.	Omloo JM, Lagarde SM, Hulscher JB, et al. Extended transthoracic resection compared with limited transhiatal resection for adenocarcinoma of the mid/distal esophagus: five-year survival of a randomized clinical trial. Ann Surg, 2007, 246(6): 992-1000.
11.	Kurokawa Y, Sasako M, Sano T, et al. Ten-year follow-up results of a randomized clinical trial comparing left thoracoabdominal and abdominal transhiatal approaches to total gastrectomy for adenocarcinoma of the oesophagogastric junction or gastric cardia. Br J Surg, 2015, 102(4): 341-348.
12.	Mariette C, Piessen G, Briez N, et al. Oesophagogastric junction adenocarcinoma: which therapeutic approach? Lancet Oncol, 2011, 12(3): 296-305.
13.	Suh YS, Lee KG, Oh SY, et al. Recurrence pattern and lymph node metastasis of adenocarcinoma at the esophagogastric junction. Ann Surg Oncol, 2017, 24(12): 3631-3639.
14.	Yamashita H, Seto Y, Sano T, et al. Results of a nation-wide retrospective study of lymphadenectomy for esophagogastric junction carcinoma. Gastric Cancer, 2017, 20(Suppl 1): 69-83.
15.	Wu XN, Liu CQ, Tian JY, et al. Prognostic significance of the number of lymph nodes examined in node-negative Siewert type Ⅱ esophagogastric junction adenocarcinoma. Int J Surg, 2017, 41: 6-11.
16.	Birla R, Hoara P, Caragui A, et al. Current management of locally advanced junction esophagogastric adenocarcinoma. Chirurgia (Bucur), 2018, 113(1): 38-45.
17.	Hatta W, Tong D, Lee YY, et al. Different time trend and management of esophagogastric junction adenocarcinoma in three Asian countries. Dig Endosc, 2017, 29(Suppl): 18-25.
18.	Mine S, Kurokawa Y, Takeuchi H, et al. Distribution of involved abdominal lymph nodes is correlated with the distance from the esophagogastric junction to the distal end of the tumor in Siewert type Ⅱ tumors. Eur J Surg Oncol, 2015, 41(10): 1348-1353.
19.	Klevebro F, Scandavini CM, Kamiya S, et al. Single center consecutive series cohort study of minimally invasive versus open resection for cancer in the esophagus or gastroesophageal junction. Dis Esophagus, 2018, 31(10). doi: 10.1093/dote/doy027.
20.	Palazzo F, Rosato EL, Chaudhary A, et al. Minimally invasive esophagectomy provides significant survival advantage compared with open or hybrid esophagectomy for patients with cancers of the esophagus and gastroesophageal junction. J Am Coll Surg, 2015, 220(4): 672-679.
21.	Sugita S, Kinoshita T, Kaito A, et al. Short-term outcomes after laparoscopic versus open transhiatal resection of Siewert type Ⅱ adenocarcinoma of the esophagogastric junction. Surg Endosc, 2018, 32(1): 383-390.

1. Siewert JR, Feith M, Stein HJ. Biologic and clinical variations of adenocarcinoma at the esophago-gastric junction: relevance of a topographic-anatomic subclassification. J Surg Oncol, 2005, 90(3): 139-146.
2. Matsuno K, Ishihara R, Ohmori M, et al. Time trends in the incidence of esophageal adenocarcinoma, gastric adenocarcinoma, and superficial esophagogastric junction adenocarcinoma. J Gastroenterol, 2019, 54(9): 784-791.
3. Matsueda K, Manabe N, Toshikuni N, et al. Clinical characteristics and associated factors of Japanese patients with adenocarcinoma of the esophagogastric junction: a multicenter clinicoepidemiological study. Dis Esophagus, 2017, 30(6): 1-6.
4. Giacopuzzi S, Bencivenga M, Weindelmayer J, et al. Western strategy for EGJ carcinoma. Gastric Cancer, 2017, 20(Suppl 1): 60-68.
5. Huang CM, Lv CB, Lin JX, et al. Laparoscopic-assisted versus open total gastrectomy for Siewert type Ⅱ and Ⅲ esophagogastric junction carcinoma: a propensity score-matched case-control study. Surg Endosc, 2017, 31(9): 3495-3503.
6. Blank S, Schmidt T, Heger P, et al. Surgical strategies in true adenocarcinoma of the esophagogastric junction (AEG Ⅱ): thoracoabdominal or abdominal approach? Gastric Cancer, 2018, 21(2): 303-314.
7. Hosoda K, Yamashita K, Moriya H, et al. Optimal treatment for Siewert type Ⅱ and Ⅲ adenocarcinoma of the esophagogastric junction: a retrospective cohort study with long-term follow-up. World J Gastroenterol, 2017, 23(15): 2723-2730.
8. 蔡杰, 彭俊, 王文凭, 等. SiewertⅡ型食管胃结合部腺癌淋巴结转移规律及手术方式的选择. 中国胸心血管外科临床杂志, 2016, 23(2): 151-155.
9. 国际食管疾病学会中国分会(CSDE)食管胃结合部疾病跨界联盟, 中国医师协会内镜医师分会腹腔镜外科专业委员会, 中国医师协会外科医师分会上消化道外科医师专业委员会, 等. 食管胃结合部腺癌外科治疗中国专家共识(2018 年版). 中华胃肠外科杂志, 2018, 21(9): 961-975.
10. Omloo JM, Lagarde SM, Hulscher JB, et al. Extended transthoracic resection compared with limited transhiatal resection for adenocarcinoma of the mid/distal esophagus: five-year survival of a randomized clinical trial. Ann Surg, 2007, 246(6): 992-1000.
11. Kurokawa Y, Sasako M, Sano T, et al. Ten-year follow-up results of a randomized clinical trial comparing left thoracoabdominal and abdominal transhiatal approaches to total gastrectomy for adenocarcinoma of the oesophagogastric junction or gastric cardia. Br J Surg, 2015, 102(4): 341-348.
12. Mariette C, Piessen G, Briez N, et al. Oesophagogastric junction adenocarcinoma: which therapeutic approach? Lancet Oncol, 2011, 12(3): 296-305.
13. Suh YS, Lee KG, Oh SY, et al. Recurrence pattern and lymph node metastasis of adenocarcinoma at the esophagogastric junction. Ann Surg Oncol, 2017, 24(12): 3631-3639.
14. Yamashita H, Seto Y, Sano T, et al. Results of a nation-wide retrospective study of lymphadenectomy for esophagogastric junction carcinoma. Gastric Cancer, 2017, 20(Suppl 1): 69-83.
15. Wu XN, Liu CQ, Tian JY, et al. Prognostic significance of the number of lymph nodes examined in node-negative Siewert type Ⅱ esophagogastric junction adenocarcinoma. Int J Surg, 2017, 41: 6-11.
16. Birla R, Hoara P, Caragui A, et al. Current management of locally advanced junction esophagogastric adenocarcinoma. Chirurgia (Bucur), 2018, 113(1): 38-45.
17. Hatta W, Tong D, Lee YY, et al. Different time trend and management of esophagogastric junction adenocarcinoma in three Asian countries. Dig Endosc, 2017, 29(Suppl): 18-25.
18. Mine S, Kurokawa Y, Takeuchi H, et al. Distribution of involved abdominal lymph nodes is correlated with the distance from the esophagogastric junction to the distal end of the tumor in Siewert type Ⅱ tumors. Eur J Surg Oncol, 2015, 41(10): 1348-1353.
19. Klevebro F, Scandavini CM, Kamiya S, et al. Single center consecutive series cohort study of minimally invasive versus open resection for cancer in the esophagus or gastroesophageal junction. Dis Esophagus, 2018, 31(10). doi: 10.1093/dote/doy027.
20. Palazzo F, Rosato EL, Chaudhary A, et al. Minimally invasive esophagectomy provides significant survival advantage compared with open or hybrid esophagectomy for patients with cancers of the esophagus and gastroesophageal junction. J Am Coll Surg, 2015, 220(4): 672-679.
21. Sugita S, Kinoshita T, Kaito A, et al. Short-term outcomes after laparoscopic versus open transhiatal resection of Siewert type Ⅱ adenocarcinoma of the esophagogastric junction. Surg Endosc, 2018, 32(1): 383-390.

Chinese Journal of Clinical Thoracic and Cardiovascular Surgery

Short-term efficacy analysis of different surgical methods for Siewert type Ⅰ and Ⅱ esophagogastric junction carcinoma

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