L Haverkamp1, J P Ruurda2, M S van Leeuwen3, P D Siersema4, R van Hillegersberg1. 1. Department of Surgery, University Medical Center Utrecht, The Netherlands. 2. Department of Surgery, University Medical Center Utrecht, The Netherlands. Electronic address: j.p.ruurda@umcutrecht.nl. 3. Department of Radiology, University Medical Center Utrecht, The Netherlands. 4. Department of Gastroenterology and Hepatology, University Medical Center Utrecht, The Netherlands.
Abstract
INTRODUCTION: The optimal surgical treatment of patients with adenocarcinoma of the gastroesophageal junction has not been established yet. OBJECTIVE: To evaluate the surgical strategies to treat adenocarcinoma of the gastroesophageal junction. METHODS: Databases Pubmed, Cochrane, and Embase were searched for "adenocarcinoma of the gastroesophageal junction" AND ("surgery" OR "esophagectomy" OR "gastrectomy") or its synonyms or abbreviations. Only comparative studies that evaluated gastrectomy versus esophagectomy were included. RESULTS: In total 10 cohort studies comparing esophagectomy versus gastrectomy fulfilled the quality criteria. The R0 resection rates varied between 72-93% for esophagectomy and 62%-93% for gastrectomy. Morbidity was 33-39% after esophagectomy versus 11-54% after gastrectomy. The 30-day mortality ranged between 1.0-2.3 after esophagectomy and 1.8-2.7% after gastrectomy. At 6 months after surgery, health-related quality of life was higher after total gastrectomy than after esophagectomy. The 5-year survival rates varied between 30-42% for esophagectomy and 18-38% for gastrectomy, but were not significantly different. CONCLUSION: No clear oncologic benefit of either esophagectomy or gastrectomy in patients with adenomacarcinoma of gastroesophageal junction could be observed. However, gastrectomy seems to be accompanied with better quality of life. Future research should preferably consist of a multicenter RCT comparing esophagectomy and gastrectomy for adenocarcinomas of the gastroesophageal junction.
INTRODUCTION: The optimal surgical treatment of patients with adenocarcinoma of the gastroesophageal junction has not been established yet. OBJECTIVE: To evaluate the surgical strategies to treat adenocarcinoma of the gastroesophageal junction. METHODS: Databases Pubmed, Cochrane, and Embase were searched for "adenocarcinoma of the gastroesophageal junction" AND ("surgery" OR "esophagectomy" OR "gastrectomy") or its synonyms or abbreviations. Only comparative studies that evaluated gastrectomy versus esophagectomy were included. RESULTS: In total 10 cohort studies comparing esophagectomy versus gastrectomy fulfilled the quality criteria. The R0 resection rates varied between 72-93% for esophagectomy and 62%-93% for gastrectomy. Morbidity was 33-39% after esophagectomy versus 11-54% after gastrectomy. The 30-day mortality ranged between 1.0-2.3 after esophagectomy and 1.8-2.7% after gastrectomy. At 6 months after surgery, health-related quality of life was higher after total gastrectomy than after esophagectomy. The 5-year survival rates varied between 30-42% for esophagectomy and 18-38% for gastrectomy, but were not significantly different. CONCLUSION: No clear oncologic benefit of either esophagectomy or gastrectomy in patients with adenomacarcinoma of gastroesophageal junction could be observed. However, gastrectomy seems to be accompanied with better quality of life. Future research should preferably consist of a multicenter RCT comparing esophagectomy and gastrectomy for adenocarcinomas of the gastroesophageal junction.
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 Journal: Gastric Cancer Date: 2017-07-06 Impact factor: 7.370