Clinical efficacy of different surgical approaches in the treatment of Siewert type Ⅱ adenocarcinoma of esophagogastric junction: A retrospective cohort study_Chinese Journal of Clinical Thoracic and Cardiovascular Surgery

Authors：

BAI Xiangdou ¹ , GOU Wenxi ² , HONG Ziqiang ¹ , CUI Baiqiang ¹ , JIN Dacheng ³ ,  GOU Yunjiu ^1,3

1. The First Clinical Medical College of Gansu University of Chinese Medicine, Lanzhou, 730000, P. R. China;
2. Southern Medical University, Guangzhou, 510000, P. R. China;
3. Department of Thoracic Surgery, Gansu Provincial People's Hospital, Lanzhou, 730000, P. R. China;

Corresponding author：

GOU Yunjiu, Email: gouyunjiu@163.com

Keywords：

Adenocarcinoma of esophagogastric junction; Siewert type Ⅱ; transabdominal diaphragmatic esophageal hiatus approach; thoracoabdominal combined with right thoracic approach; lymph node dissection; survival benefit

DOI：

10.7507/1007-4848.202207079

Video：

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Objective To compare the clinical efficacy of different surgical approaches for Siewert type Ⅱ adenocarcinoma of esophagogastric junction (AEG). Methods The clinical data of the patients with Siewert type Ⅱ AEG who received sugeries in the Department of Thoracic Surgery of Gansu Provincial People's Hospital from August 2014 to December 2019 were retrospectively analyzed. The patients were divided into two groups according to the surgical approach: a transabdominal group (transabdominal diaphragmatic esophageal hiatus approach) and a combined group (thoracoabdominal combined with right thoracic approach). Perioperative clinical data and postoperative follow-up data were collected to compare the short- and long-term efficacy of the two groups. Results A total of 87 patients were enrolled. There were 48 patients (31 males and 17 females, with an average age of 60.85±8.47 years) in the transabdominal group, and 39 patients (25 males and 14 females, with an average age of 61.13±8.51 years) in the combined group. There was no statistical difference between the two groups in the baseline indicators such as gender, age, tumor size and stage (P>0.05). Compared with the combined group, the operation time, intraoperative blood loss, postoperative bed rest time, postoperative total drainage volume were shorter or less, and the visual analogue scale score on the 3rd day after surgery were lower in the transabdominal group (P<0.05). However, the total number of lymph nodes dissected, the number of thoracic lymph nodes dissected and the number of positive thoracic lymph nodes in the combined group were larger than those in the transabdominal group, and the differences were statistically significant (P=0.001). The median survival time in the combined group and transabdominal group was 25.85 months and 20.86 months, respectively. The 3-year overall survival rate of the combined group was higher than that of the transabdominal group (46.2% vs. 38.9%, χ²=5.995, P=0.014). However, there was no statistical difference between the two groups in the postoperative catheter time, esophageal and gastric resection margin distance, number of abdominal lymph nodes dissected, number of positive abdominal lymph nodes, or incidence of postoperative complications (P>0.05). Conclusion For patients with Siewert type Ⅱ adenocarcinoma of esophagogastric junction, thoracoabdominal combined with right thoracic approach is safe and effective, and has advantages in thoracic lymph node dissection, bringing more benefits to the patients, so it is recommended to be popularized in clinical practice.

Citation： BAI Xiangdou, GOU Wenxi, HONG Ziqiang, CUI Baiqiang, JIN Dacheng, GOU Yunjiu. Clinical efficacy of different surgical approaches in the treatment of Siewert type Ⅱ adenocarcinoma of esophagogastric junction: A retrospective cohort study. Chinese Journal of Clinical Thoracic and Cardiovascular Surgery, 2024, 31(3): 371-375. doi: 10.7507/1007-4848.202207079 Copy

1.	Kumamoto T, Kurahashi Y, Niwa H, et al. True esophagogastric junction adenocarcinoma: Background of its definition and current surgical trends. Surg Today, 2020, 50(8): 809-814.
2.	Yanagimoto Y, Kurokawa Y, Doki Y, et al. Surgical and perioperative treatment strategy for resectable esophagogastric junction cancer. Jpn J Clin Oncol, 2022, 52(5): 417-424.
3.	Cao F, Hu C, Xu ZY, et al. Current treatments and outlook in adenocarcinoma of the esophagogastric junction: A narrative review. Ann Transl Med, 2022, 10(6): 377.
4.	Nobel T, Molena D. Surgical principles for optimal treatment of esophagogastric junction adenocarcinoma. Ann Gastroenterol Surg, 2019, 3(4): 390-395.
5.	Zhang S, Orita H, Fukunaga T. Current surgical treatment of esophagogastric junction adenocarcinoma. World J Gastrointest Oncol, 2019, 11(8): 567-578.
6.	Xiong W, Chen Y, Zhu X, et al. Transthoracic single-port assisted laparoscopic five-step maneuver lower mediastinal lymphadenectomy for Siewert typeⅡadenocarcinoma of the esophagogastric junction. Ann Surg Oncol, 2022, 29(6): 3936-3937.
7.	Sugita S, Kinoshita T, Kuwata T, et al. Long-term oncological outcomes of laparoscopic versus open transhiatal resection for patients with Siewert type Ⅱ adenocarcinoma of the esophagogastric junction. Surg Endosc, 2021, 35(1): 340-348.
8.	陈龙奇, 胡建昆, 季加孚, 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.
9.	郑民华, 臧潞, 马君俊, 等. SiewertⅡ型食管胃结合部腺癌腔镜手术治疗中国专家共识 (2019版). 中国实用外科杂志, 2019, 39(11): 1129-1135.
10.	李双喜, 李子禹. 食管胃结合部腺癌腹腔镜手术的下纵隔淋巴结清扫边界及质量控制. 中华胃肠外科杂志, 2022, 25(2): 120-123.
11.	李珍艳, 顾一敏, 王文凭, 等. 从胸外科视角看SiewertⅡ型食管胃结合部腺癌的治疗. 中华胃肠外科杂志, 2022, 25(2): 109-113.
12.	谭黎杰. 食管胃结合部腺癌经胸路径手术的利与弊. 中华胃肠外科杂志, 2022, 25(2): 147-150.
13.	Oh SE, Lee GH, An JY, et al. Comparison of transabdominal and transthoracic surgical approaches in the treatment of Siewert type Ⅱ esophagogastric junction cancers: A propensity score-matching analysis. Eur J Surg Oncol, 2022, 48(2): 370-376.
14.	Wu H, Shang L, Du F, et al. Transhiatal versus transthoracic surgical approach for Siewert type Ⅱ adenocarcinoma of the esophagogastric junction: A meta-analysis. Expert Rev Gastroenterol Hepatol, 2020, 14(11): 1107-1117.
15.	Feith M, Stein HJ, Siewert JR. Adenocarcinoma of the esophagogastric junction: Surgical therapy based on 1 602 consecutive resected patients. Surg Oncol Clin N Am, 2006, 15(4): 751-764.
16.	Kurokawa Y, Takeuchi H, Doki Y, et al. Mapping of lymph node metastasis from esophagogastric junction tumors: A prospective nationwide multicenter study. Ann Surg, 2021, 274(1): 120-127.
17.	Peng J, Wang WP, Yuan Y, et al. Optimal extent of lymph node dissection for Siewert type Ⅱ esophagogastric junction adenocarcinoma. Ann Thorac Surg, 2015, 100(1): 263-269.
18.	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.
19.	Barbour AP, Rizk NP, Gonen M, et al. Adenocarcinoma of the gastroesophageal junction: Influence of esophageal resection margin and operative approach on outcome. Ann Surg, 2007, 246(1): 1-8.

1. Kumamoto T, Kurahashi Y, Niwa H, et al. True esophagogastric junction adenocarcinoma: Background of its definition and current surgical trends. Surg Today, 2020, 50(8): 809-814.
2. Yanagimoto Y, Kurokawa Y, Doki Y, et al. Surgical and perioperative treatment strategy for resectable esophagogastric junction cancer. Jpn J Clin Oncol, 2022, 52(5): 417-424.
3. Cao F, Hu C, Xu ZY, et al. Current treatments and outlook in adenocarcinoma of the esophagogastric junction: A narrative review. Ann Transl Med, 2022, 10(6): 377.
4. Nobel T, Molena D. Surgical principles for optimal treatment of esophagogastric junction adenocarcinoma. Ann Gastroenterol Surg, 2019, 3(4): 390-395.
5. Zhang S, Orita H, Fukunaga T. Current surgical treatment of esophagogastric junction adenocarcinoma. World J Gastrointest Oncol, 2019, 11(8): 567-578.
6. Xiong W, Chen Y, Zhu X, et al. Transthoracic single-port assisted laparoscopic five-step maneuver lower mediastinal lymphadenectomy for Siewert typeⅡadenocarcinoma of the esophagogastric junction. Ann Surg Oncol, 2022, 29(6): 3936-3937.
7. Sugita S, Kinoshita T, Kuwata T, et al. Long-term oncological outcomes of laparoscopic versus open transhiatal resection for patients with Siewert type Ⅱ adenocarcinoma of the esophagogastric junction. Surg Endosc, 2021, 35(1): 340-348.
8. 陈龙奇, 胡建昆, 季加孚, 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.
9. 郑民华, 臧潞, 马君俊, 等. SiewertⅡ型食管胃结合部腺癌腔镜手术治疗中国专家共识 (2019版). 中国实用外科杂志, 2019, 39(11): 1129-1135.
10. 李双喜, 李子禹. 食管胃结合部腺癌腹腔镜手术的下纵隔淋巴结清扫边界及质量控制. 中华胃肠外科杂志, 2022, 25(2): 120-123.
11. 李珍艳, 顾一敏, 王文凭, 等. 从胸外科视角看SiewertⅡ型食管胃结合部腺癌的治疗. 中华胃肠外科杂志, 2022, 25(2): 109-113.
12. 谭黎杰. 食管胃结合部腺癌经胸路径手术的利与弊. 中华胃肠外科杂志, 2022, 25(2): 147-150.
13. Oh SE, Lee GH, An JY, et al. Comparison of transabdominal and transthoracic surgical approaches in the treatment of Siewert type Ⅱ esophagogastric junction cancers: A propensity score-matching analysis. Eur J Surg Oncol, 2022, 48(2): 370-376.
14. Wu H, Shang L, Du F, et al. Transhiatal versus transthoracic surgical approach for Siewert type Ⅱ adenocarcinoma of the esophagogastric junction: A meta-analysis. Expert Rev Gastroenterol Hepatol, 2020, 14(11): 1107-1117.
15. Feith M, Stein HJ, Siewert JR. Adenocarcinoma of the esophagogastric junction: Surgical therapy based on 1 602 consecutive resected patients. Surg Oncol Clin N Am, 2006, 15(4): 751-764.
16. Kurokawa Y, Takeuchi H, Doki Y, et al. Mapping of lymph node metastasis from esophagogastric junction tumors: A prospective nationwide multicenter study. Ann Surg, 2021, 274(1): 120-127.
17. Peng J, Wang WP, Yuan Y, et al. Optimal extent of lymph node dissection for Siewert type Ⅱ esophagogastric junction adenocarcinoma. Ann Thorac Surg, 2015, 100(1): 263-269.
18. 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.
19. Barbour AP, Rizk NP, Gonen M, et al. Adenocarcinoma of the gastroesophageal junction: Influence of esophageal resection margin and operative approach on outcome. Ann Surg, 2007, 246(1): 1-8.

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Clinical efficacy of different surgical approaches in the treatment of Siewert type Ⅱ adenocarcinoma of esophagogastric junction: A retrospective cohort study

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