Susanne Blank1, Thomas Schmidt2, Patrick Heger1, Moritz J Strowitzki1, Leila Sisic1, Ulrike Heger1, Henrik Nienhueser1, Georg Martin Haag3, Thomas Bruckner4, André L Mihaljevic1, Katja Ott5, Markus W Büchler1, Alexis Ulrich1. 1. Department of General, Visceral and Transplantation Surgery, University Hospital Heidelberg, Im Neuenheimer Feld 110, 69120, Heidelberg, Germany. 2. Department of General, Visceral and Transplantation Surgery, University Hospital Heidelberg, Im Neuenheimer Feld 110, 69120, Heidelberg, Germany. Thomas.Schmidt1@med.uni-heidelberg.de. 3. Department of Medical Oncology, National Center for Tumor Diseases, University of Heidelberg, Im Neuenheimer Feld 460, 69120, Heidelberg, Germany. 4. Institute for Medical Biometry and Informatics, Im Neuenheimer Feld 130.3, 69120, Heidelberg, Germany. 5. Romed Klinikum Rosenheim, Pettenkoferstr. 10, 83022, Rosenheim, Germany.
Abstract
BACKGROUND: The optimal surgical approach for adenocarcinoma directly at the esophagogastric junction (AEG II) is still under debate. This study aims to evaluate the differences between right thoracoabdominal esophagectomy (TAE) (Ivor-Lewis operation) and transhiatal extended gastrectomy (THG) for AEG II. METHODS: From a prospective database, 242 patients with AEG II (TAE, n = 56; THG, n = 186) were included and analyzed according to characteristics and perioperative morbidity and mortality and overall survival (chi-square, Mann-Whitney U, log-rank, Cox regression). RESULTS: Groups were comparable at baseline with exception of age. Patients older than 70 years were more frequently resected by THG (p = 0.003). No differences in perioperative morbidity (p = 0.197) and mortality (p = 0.711) were observed, including anastomotic leakages (p = 0.625) and pulmonary complications (p = 0.494). There was no significant difference in R0 resection (p = 0.719) and number of resected lymph nodes (p = 0.202). Overall median survival was 38.4 months. Survival after TAE was significantly longer than after THG (median OS not reached versus 33.6 months, p = 0.02). Multivariate analysis revealed pN-category (p < 0.001) and type of surgery (p = 0.017) as independent prognostic factors. The type of surgery was confirmed as prognostic factor in locally advanced AEG II (cT 3/4 or cN1), but not in cT1/2 and cN0 patients. CONCLUSIONS: Our single-center experience suggests that patients with (locally advanced) AEG II tumors may benefit from TAE compared to THG. For further evaluation, a randomized trial would be necessary.
BACKGROUND: The optimal surgical approach for adenocarcinoma directly at the esophagogastric junction (AEG II) is still under debate. This study aims to evaluate the differences between right thoracoabdominal esophagectomy (TAE) (Ivor-Lewis operation) and transhiatal extended gastrectomy (THG) for AEG II. METHODS: From a prospective database, 242 patients with AEG II (TAE, n = 56; THG, n = 186) were included and analyzed according to characteristics and perioperative morbidity and mortality and overall survival (chi-square, Mann-Whitney U, log-rank, Cox regression). RESULTS: Groups were comparable at baseline with exception of age. Patients older than 70 years were more frequently resected by THG (p = 0.003). No differences in perioperative morbidity (p = 0.197) and mortality (p = 0.711) were observed, including anastomotic leakages (p = 0.625) and pulmonary complications (p = 0.494). There was no significant difference in R0 resection (p = 0.719) and number of resected lymph nodes (p = 0.202). Overall median survival was 38.4 months. Survival after TAE was significantly longer than after THG (median OS not reached versus 33.6 months, p = 0.02). Multivariate analysis revealed pN-category (p < 0.001) and type of surgery (p = 0.017) as independent prognostic factors. The type of surgery was confirmed as prognostic factor in locally advanced AEG II (cT 3/4 or cN1), but not in cT1/2 and cN0 patients. CONCLUSIONS: Our single-center experience suggests that patients with (locally advanced) AEG II tumors may benefit from TAE compared to THG. For further evaluation, a randomized trial would be necessary.
Entities:
Keywords:
AEG II; Adenocarcinoma of the cardia; Ivor–Lewis operation; Thoracoabdominal esophagectomy; Transhiatal extended gastrectomy
Authors: P van Hagen; M C C M Hulshof; J J B van Lanschot; E W Steyerberg; M I van Berge Henegouwen; B P L Wijnhoven; D J Richel; G A P Nieuwenhuijzen; G A P Hospers; J J Bonenkamp; M A Cuesta; R J B Blaisse; O R C Busch; F J W ten Kate; G-J Creemers; C J A Punt; J T M Plukker; H M W Verheul; E J Spillenaar Bilgen; H van Dekken; M J C van der Sangen; T Rozema; K Biermann; J C Beukema; A H M Piet; C M van Rij; J G Reinders; H W Tilanus; A van der Gaast Journal: N Engl J Med Date: 2012-05-31 Impact factor: 91.245
Authors: Luis F Tapias; Douglas J Mathisen; Cameron D Wright; John C Wain; Henning A Gaissert; Ashok Muniappan; Michael Lanuti; Dean M Donahue; Christopher R Morse Journal: Ann Thorac Surg Date: 2015-12-01 Impact factor: 4.330
Authors: Hiromichi Ito; Thomas E Clancy; Robert T Osteen; Richard S Swanson; Raphael Bueno; David J Sugarbaker; Stanley W Ashley; Michael J Zinner; Edward E Whang Journal: J Am Coll Surg Date: 2004-12 Impact factor: 6.113
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: Marcel Hochreiter; Maria Uhling; Leila Sisic; Thomas Bruckner; Alexandra Heininger; Andreas Hohn; Katja Ott; Thomas Schmidt; Marc Moritz Berger; Daniel Christoph Richter; Markus Büchler; Markus Alexander Weigand; Cornelius Johannes Busch Journal: Infection Date: 2018-06-05 Impact factor: 3.553
Authors: Marcel Hochreiter; Thomas Schmidt; Benedikt H Siegler; Leila Sisic; Karsten Schmidt; Thomas Bruckner; Beat P Müller-Stich; Markus K Diener; Markus A Weigand; Markus W Büchler; Cornelius J Busch Journal: World J Surg Date: 2020-07 Impact factor: 3.352
Authors: Enrique Norero; Jose Luis Quezada; Jaime Cerda; Marco Ceroni; Cristian Martinez; Ricardo Mejía; Rodrigo Muñoz; Fernando Araos; Paulina González; Alfonso Díaz Journal: Arq Bras Cir Dig Date: 2019-12-20