Shizuki Sugita1, Takahiro Kinoshita2, Akio Kaito1, Masahiro Watanabe1, Hideki Sunagawa1. 1. Gastric Surgery Division, National Cancer Center Hospital East, 6-5-1, Kashiwanoha, Kashiwa, Chiba, 277-8577, Japan. 2. Gastric Surgery Division, National Cancer Center Hospital East, 6-5-1, Kashiwanoha, Kashiwa, Chiba, 277-8577, Japan. takkinos@east.ncc.go.jp.
Abstract
BACKGROUND: The potential advantages of laparoscopic surgery (LS) compared with open surgery (OS) for Siewert type II adenocarcinoma of the esophagogastric junction (AEG) have not been fully clarified. This study aimed to assess the feasibility and safety of the laparoscopic transhiatal approach for Siewert type II AEG, and compare the short-term outcomes of LS versus OS for Siewert type II AEG. METHODS: We retrospectively analyzed 87 consecutive patients with Siewert type II AEG who underwent curative surgery from January 2008 to November 2016. Surgery-related short-term variables were analyzed in LS versus OS. RESULTS: Forty-five patients underwent LS, and 42 underwent OS. Compared with OS, LS was associated with significantly less intraoperative blood loss (11 vs. 408 ml, p < 0.001) and extended operation time (256 vs. 226 min, p = 0.001). There was no significant difference between LS and OS in postoperative hospitalization duration (9 vs. 10 days, p = 0.193) or rate of surgical morbidity (≥grade 3) for complications such as anastomotic leakage (4.4 vs. 4.8%, p = 1.000), or pancreatic leakage (4.4 vs. 9.5%, p = 0.423), and there were no pulmonary-associated complications in either group. There was no difference between groups in total number of harvested lymph nodes (24 vs. 29, p = 0.502), but the number of harvested mediastinum LNs was larger in LS (2 vs. 1, p = 0.002). There was no difference between groups in the length of the proximal margin (9 vs. 10 mm, p = 0.246), and the margins were negative in all cases in both groups. CONCLUSIONS: Laparoscopic transhiatal resection for Siewert type II AEG is technically challenging, but appears feasible and safe in technical or short-term oncological aspects when performed by an experienced surgical team. A large-scale prospective study is needed to evaluate long-term outcomes.
BACKGROUND: The potential advantages of laparoscopic surgery (LS) compared with open surgery (OS) for Siewert type II adenocarcinoma of the esophagogastric junction (AEG) have not been fully clarified. This study aimed to assess the feasibility and safety of the laparoscopic transhiatal approach for Siewert type II AEG, and compare the short-term outcomes of LS versus OS for Siewert type II AEG. METHODS: We retrospectively analyzed 87 consecutive patients with Siewert type II AEG who underwent curative surgery from January 2008 to November 2016. Surgery-related short-term variables were analyzed in LS versus OS. RESULTS: Forty-five patients underwent LS, and 42 underwent OS. Compared with OS, LS was associated with significantly less intraoperative blood loss (11 vs. 408 ml, p < 0.001) and extended operation time (256 vs. 226 min, p = 0.001). There was no significant difference between LS and OS in postoperative hospitalization duration (9 vs. 10 days, p = 0.193) or rate of surgical morbidity (≥grade 3) for complications such as anastomotic leakage (4.4 vs. 4.8%, p = 1.000), or pancreatic leakage (4.4 vs. 9.5%, p = 0.423), and there were no pulmonary-associated complications in either group. There was no difference between groups in total number of harvested lymph nodes (24 vs. 29, p = 0.502), but the number of harvested mediastinum LNs was larger in LS (2 vs. 1, p = 0.002). There was no difference between groups in the length of the proximal margin (9 vs. 10 mm, p = 0.246), and the margins were negative in all cases in both groups. CONCLUSIONS: Laparoscopic transhiatal resection for Siewert type II AEG is technically challenging, but appears feasible and safe in technical or short-term oncological aspects when performed by an experienced surgical team. A large-scale prospective study is needed to evaluate long-term outcomes.
Entities:
Keywords:
Esophagogastric junction; Laparoscopic gastrectomy; Siewert type II; Transhiatal approach
Authors: Massimiliano Bissolati; Matteo Desio; Fausto Rosa; Stefano Rausei; Daniele Marrelli; Gian Luca Baiocchi; Giovanni De Manzoni; Damiano Chiari; Giovanni Guarneri; Fabio Pacelli; Lorenzo De Franco; Sarah Molfino; Chiara Cipollari; Elena Orsenigo Journal: Gastric Cancer Date: 2016-01-05 Impact factor: 7.370
Authors: Leonie Haverkamp; Teus J Weijs; Pieter C van der Sluis; Ingeborg van der Tweel; Jelle P Ruurda; Richard van Hillegersberg Journal: Surg Endosc Date: 2012-12-14 Impact factor: 4.584
Authors: Y Kurokawa; M Sasako; T Sano; T Yoshikawa; Y Iwasaki; A Nashimoto; S Ito; A Kurita; J Mizusawa; K Nakamura Journal: Br J Surg Date: 2015-01-21 Impact factor: 6.939
Authors: Qing Feng; Du Long; Ming-Shan Du; Xiao-Song Wang; Zhen-Shun Li; Yong-Liang Zhao; Feng Qian; Yan Wen; Pei-Wu Yu; Yan Shi Journal: Front Oncol Date: 2021-09-29 Impact factor: 6.244