A comparative study of complete laparoscopic transabdominal approach and transabdominal combined thoracotomy approach in treatment of Siewert type <b>Ⅱ</b> esophageal gastric junction adenocarcinoma_CHINESE JOURNAL OF BASES AND CLINICS IN GENERAL SURGERY

Authors：

SONG Shunyao ¹ , HAN Lu ² , YUAN Qingzhong ³ ,  SUN Zuocheng ⁴

1. Weifang Medical University, Weifang, Shandong 261000, P. R. China;
2. The First Affiliated Hospital of Weifang Medical University/Three Health Care Departments of Weifang People’s Hospital, Weifang, Shandong 261000, P. R. China;
3. Hepatobiliary Surgery, Shengli Oilfield Central Hospital, Dongying, Shandong 257000, P. R. China;
4. The First Affiliated Hospital of Weifang Medical University/The First Ward of General Surgery (Gastrointestinal Surgery) of Weifang People’s Hospital, Weifang, Shandong 261000, P. R. China;

Corresponding author：

SUN Zuocheng, Email: wfphszc@126.com

Keywords：

adenocarcinoma of esophagogastric gunction; Siewert type Ⅱ; complete laparoscopy; transesophageal hiatus approach; transabdominal combined thoracotomy approach; security

DOI：

10.7507/1007-9424.202003029

Video：

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Objective To investigate therapeutic effect and influence on survival of complete laparoscopic transesophageal hiatus approach approach and transabdominal combined thoracotomy approach in treatment of Siewert type Ⅱesophageal gastric junction adenocarcinoma (AEG).Methods From January 2012 to December 2014, the patients with Siewert type Ⅱ AEG were collected in the Department of General Surgery (Gastrointestinal Surgery) of Weifang People’s Hospital, then who were designed into a transabdominal group and transabdominal combined thoracotomy group according to the operative approach method. The intraoperative and postoperative statuses were compared between these two groups.Results In this study, 142 patients with Siewert type Ⅱ AEG were included, 83 in the transabdominal group and 59 in the transabdominal combined thoracotomy group. There were no significant differences in the baseline data such as the gender, age, preoperative histological differentiation, TNM stage, etc. between the two groups (P>0.05). Compared with the transabdominal combined thoracotomy group, in terms of the operation time, the volumes of intraoperative blood loss and blood transfusion, and the proportion of patients with blood transfusion were better (P<0.05); the postoperative hospitalization time, time to use analgesics, time of the first activity out of bed, and time of removed electrocardiographic monitoring were also earlier (P<0.05); the numbers of lymphadenectomy and metastatic lymph nodes were less (P<0.05) in the transabdominal group. But there was no significant difference in the rate of lymph node metastasis between the two groups (P>0.05). The total incidence of complications in the transabdominal group was lower than that in the transabdominal combined thoracotomy group (χ²=9.871, P=0.002). The median survival time was 39 months in the transabdominal group and 34 months in the transabdominal combined thoracotomy group. The survival had no significant difference between the two groups by the Kaplan-Meier analysis (χ²=0.281, P=0.596). The result of multivariate analysis showed that the TNM stage and lymph node positive rate were the independent factors influencing the survival of the patients with Siewert type Ⅱ AEG.Conclusions According to results of this study, it is safe and effective for patients with Siewert type Ⅱ AEG to adopt a complete laparoscopic transabdominal approach. For elderly patients with poor cardiopulmonary function who can not tolerate transthoracic surgery, it could reduce postoperative complications and improve safety.

Citation： SONG Shunyao, HAN Lu, YUAN Qingzhong, SUN Zuocheng. A comparative study of complete laparoscopic transabdominal approach and transabdominal combined thoracotomy approach in treatment of Siewert type Ⅱ esophageal gastric junction adenocarcinoma. CHINESE JOURNAL OF BASES AND CLINICS IN GENERAL SURGERY, 2020, 27(10): 1259-1265. doi: 10.7507/1007-9424.202003029 Copy

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2.	Goto H, Tokunaga M, Miki Y, <italic>et al</italic>. The optimal extent of lymph node dissection for adenocarcinoma of the esophagogastric junction differs between Siewert type Ⅱ and Siewert type Ⅲ patients. Gastric Cancer, 2014, 18(2): 375-381.
3.	Siewert JR, Stein HJ. Classification of adenocarcinoma of the oesophagogastric junction. Br J Surg, 1998, 85(11): 1457-1459.
4.	Rüdiger Siewert J, Feith M, Werner M, <italic>et al</italic>. Adenocarcinoma of the esophagogastric junction: results of surgical therapy based on anatomical/topographic classification in 1 002 consecutive patients. Ann Surg, 2000, 232(3): 353-361.
5.	Powell J, McConkey CC. The rising trend in oesophageal adenocarcinoma and gastric cardia. Eur J Cancer Prev, 1992, 1(3): 265-269.
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8.	Wang R, Chen XZ. High mortality from hepatic, gastric and esophageal cancers in mainland China: 40 years of experience and development. Clin Res Hepatol Gastroenterol, 2014, 38(6): 751756.
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15.	Sugita S, Kinoshita T, Kaito A, <italic>et al</italic>. Short-term outcomes after laparoscopic <italic>versus</italic> open transhiatal resection of Siewert type Ⅱ adenocarcinoma of the esophagogastric junction. Surg Endosc, 2018, 32(1): 383-390.
16.	Kim HH, Hyung WJ, Cho GS, <italic>et al</italic>. Morbidity and mortality of laparoscopic gastrectomy <italic>versus</italic> open gastrectomy for gastric cancer: An interim report-A phase Ⅲ multicenter, prospective, randomized trial (KLASS Trial). Ann Surg, 2010, 251(3): 417-420.
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19.	Yamashita H, Katai H, Morita S, <italic>et al</italic>. Optimal extent of lymph node dissection for Siewert type Ⅱ esophagogastric junction carcinoma. Ann Surg, 2011, 254(2): 274-280.
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21.	Kurokawa Y, Takeuchi H, Doki Y, et al. Mapping of lymph node metastasis from esophagogastric junction tumors: a prospective nationwide multicenter study. Ann Surg, 2019 Aug 8. doi: 10.1097/SLA.0000000000003499.
22.	Sasako M, McCulloch P, Kinoshita T, <italic>et al</italic>. New method to evaluate the therapeutic value of lymph node dissection for gastric cancer. Br J Surg, 1995, 82(3): 346-351.
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24.	Goto H, Tokunaga M, Sugisawa N, <italic>et al</italic>. Value of splenectomy in patients with Siewert type II adenocarcinoma of the esophagogastric junction. Gastric Cancer, 2013, 16(4): 590-595.
25.	Nishi M, Kajisa T, Akune T, <italic>et al</italic>. Cardia cancer proposal of cancer in the esophagogastric junction. Geka Shinryo (Surgical Diagnosis and Treatment), 1973, 15: 1328-1338.
26.	中华人民共和国国家卫生健康委员会. 胃癌诊疗规范(2018 年版). 肿瘤综合治疗电子杂志, 2019, 5(1): 55-82.
27.	杨世界, 袁勇, 胡皓源, 等. Siewert Ⅱ型食管胃结合部腺癌经胸与经腹入路手术的预后比较—胸外科与胃肠外科联合数据分析. 中华胃肠外科杂志, 2019, 22(2): 132-142.
28.	Japanese Gastric Cancer Association. Japanese gastric cancer treatment guidelines 2018 (5th edition). Gastric Cancer, 2020 Feb 14.

1. Hamilton SR, Aaltonen LA (Eds.). World Health Organization classification of tumours. Pathology and genetics of tumours of the digestive system. Lyon: International Agency for Research on Cancer (IARC) Press, 2000.
2. Goto H, Tokunaga M, Miki Y, <italic>et al</italic>. The optimal extent of lymph node dissection for adenocarcinoma of the esophagogastric junction differs between Siewert type Ⅱ and Siewert type Ⅲ patients. Gastric Cancer, 2014, 18(2): 375-381.
3. Siewert JR, Stein HJ. Classification of adenocarcinoma of the oesophagogastric junction. Br J Surg, 1998, 85(11): 1457-1459.
4. Rüdiger Siewert J, Feith M, Werner M, <italic>et al</italic>. Adenocarcinoma of the esophagogastric junction: results of surgical therapy based on anatomical/topographic classification in 1 002 consecutive patients. Ann Surg, 2000, 232(3): 353-361.
5. Powell J, McConkey CC. The rising trend in oesophageal adenocarcinoma and gastric cardia. Eur J Cancer Prev, 1992, 1(3): 265-269.
6. Kusano C, Gotoda T, Khor CJ, <italic>et al</italic>. Changing trends in the proportion of adenocarcinoma of the esophagogastric junction in alarge tertiary referral center in Japan. J Gastroenterol Hepatol, 2008, 23(11): 1662-1665.
7. Liu K, Yang K, Zhang W, <italic>et al</italic>. Changes of esophagogastric junctional adenocarcinoma and gastroesophageal reflux disease among surgical patients during 1988-2012: A single-institution, high-volume experience in China. Ann Surg, 2016, 263(1): 88-95.
8. Wang R, Chen XZ. High mortality from hepatic, gastric and esophageal cancers in mainland China: 40 years of experience and development. Clin Res Hepatol Gastroenterol, 2014, 38(6): 751756.
9. Kodera Y, Yamamura Y, Shimizu Y, <italic>et al</italic>. Adenocarcinoma of the gastroesophageal junction in Japan: relevance of Siewert’s classification applied to 177 cases resected at a single institution. J Am Coll Surg, 1999, 189(6): 594-601.
10. 徐宇, 朱蕙燕, 龙子雯, 等. 食管胃结合部腺癌的预后分析. 中国癌症杂志, 2010, 20(6): 446-451.
11. 季加孚, 季科. 食管胃结合部腺癌外科治疗进展. 中国普外基础与临床杂志, 2019, 26(9): 1021-1024.
12. 中华医学会外科学分会腹腔镜与内镜外科学组. Siewert Ⅱ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.
13. Sasako M, Sano T, Yamamoto S, <italic>et al</italic>. Left thoracoabdominal approach <italic>versus</italic> abdominal-transhiatal approach for gastric cancer of the cardia or subcardia: a randomised controlled trial. Lancet Oncol, 2006, 7(8): 644-651.
14. 叶永志, 李永文, 洪清琦, 等. Siewert Ⅱ型和Ⅲ型食管胃结合部腺癌经腹入路腹腔镜辅助和开腹根治术疗效及预后因素分析. 中华消化外科杂志, 2018, 17(8): 836-842.
15. Sugita S, Kinoshita T, Kaito A, <italic>et al</italic>. Short-term outcomes after laparoscopic <italic>versus</italic> open transhiatal resection of Siewert type Ⅱ adenocarcinoma of the esophagogastric junction. Surg Endosc, 2018, 32(1): 383-390.
16. Kim HH, Hyung WJ, Cho GS, <italic>et al</italic>. Morbidity and mortality of laparoscopic gastrectomy <italic>versus</italic> open gastrectomy for gastric cancer: An interim report-A phase Ⅲ multicenter, prospective, randomized trial (KLASS Trial). Ann Surg, 2010, 251(3): 417-420.
17. Viñuela EF, Gonen M, Brennan MF, <italic>et al</italic>. Laparoscopic <italic>versus</italic> open distal gastrectomy for gastric cancer: a meta-analysis of randomized controlled trials and high-quality nonrandomized studies. Ann Surg, 2012, 255(3): 446-456.
18. Hosokawa Y, Kinoshita T, Konishi M, <italic>et al</italic>. Clinicopathological features and prognostic factors of adenocarcinoma of the esophagogastric junction according to Siewert classification: Experiences at a single institution in Japan. Ann Surg Oncol, 2012, 19(2): 677-683.
19. Yamashita H, Katai H, Morita S, <italic>et al</italic>. Optimal extent of lymph node dissection for Siewert type Ⅱ esophagogastric junction carcinoma. Ann Surg, 2011, 254(2): 274-280.
20. Mine S, Sano T, Hiki N, <italic>et al</italic>. Lymphadenectomy around the left renal vein in Siewert type Ⅱ adenocarcinoma of the oesophagogastric junction. Br J Surg, 2013, 100(2): 261-266.
21. Kurokawa Y, Takeuchi H, Doki Y, et al. Mapping of lymph node metastasis from esophagogastric junction tumors: a prospective nationwide multicenter study. Ann Surg, 2019 Aug 8. doi: 10.1097/SLA.0000000000003499.
22. Sasako M, McCulloch P, Kinoshita T, <italic>et al</italic>. New method to evaluate the therapeutic value of lymph node dissection for gastric cancer. Br J Surg, 1995, 82(3): 346-351.
23. Fujitani K, Miyashiro I, Mikata S, <italic>et al</italic>. Pattern of abdominal nodal spread and optimal abdominal lymphadenectomy for advanced Siewert type Ⅱ adenocarcinoma of the cardia: results of a multicenter study. Gastric Cancer, 2013, 16(3): 301-308.
24. Goto H, Tokunaga M, Sugisawa N, <italic>et al</italic>. Value of splenectomy in patients with Siewert type II adenocarcinoma of the esophagogastric junction. Gastric Cancer, 2013, 16(4): 590-595.
25. Nishi M, Kajisa T, Akune T, <italic>et al</italic>. Cardia cancer proposal of cancer in the esophagogastric junction. Geka Shinryo (Surgical Diagnosis and Treatment), 1973, 15: 1328-1338.
26. 中华人民共和国国家卫生健康委员会. 胃癌诊疗规范(2018 年版). 肿瘤综合治疗电子杂志, 2019, 5(1): 55-82.
27. 杨世界, 袁勇, 胡皓源, 等. Siewert Ⅱ型食管胃结合部腺癌经胸与经腹入路手术的预后比较—胸外科与胃肠外科联合数据分析. 中华胃肠外科杂志, 2019, 22(2): 132-142.
28. Japanese Gastric Cancer Association. Japanese gastric cancer treatment guidelines 2018 (5th edition). Gastric Cancer, 2020 Feb 14.

CHINESE JOURNAL OF BASES AND CLINICS IN GENERAL SURGERY

A comparative study of complete laparoscopic transabdominal approach and transabdominal combined thoracotomy approach in treatment of Siewert type Ⅱ esophageal gastric junction adenocarcinoma

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