Rossella Reddavid1, Paolo Strignano2, Silvia Sofia1, Andrea Evangelista3, Giacomo Deiro4, Gaspare Cannata5, Paolo Chiaro6, Fabio Maiello7, Michela Mineccia8, Alessandro Ferrero8, Renzo Leli6, Sergio Gentilli4, Roberto Polastri7, Felice Borghi5, Michele Camandona9, Renato Romagnoli2, Mario Morino9, Maurizio Degiuli10. 1. University of Turin. Department of Oncology, Surgical Oncology and Digestive Surgery Unit, San Luigi University Hospital (S.L.U.H.), Regione Gonzole 10, 10049, Orbassano, Turin, Italy. 2. University of Turin, Department os Surgical Sciences, Unit of General Surgery 2U, Ospedale Molinette, AOU Città della Salute e della Scienza di Torino, Corso Bramante 88, 10126, Turin, Italy. 3. Unit of Clinical Epidemiology, AOU Città della Salute e della Scienza di Torino and Centro di Riferimento per l'Epidemiologia e la Prevenzione Oncologica in Piemonte (CPO), Corso Bramante 88, 10126, Turin, Italy. 4. University of Eastern Piedmont, Department of Health Sciences, General Surgery Unit Ospedale Maggiore della Carita, Corso Mazzini 18, 28100, Novara, Italy. 5. Unit of General and Oncological Surgery, Department of Surgery, ASO SS Croce e Carle, V Coppino 26, 12100, Cuneo, Italy. 6. Unit of General Surgery, Ospedale S Giovanni Bosco, Piazza del Donatore di Sangue 3, 10154, Turin, Italy. 7. Department of General Surgery, Ospedale degli Infermi di Biella, Via dei Ponderanesi 2, 13900, Ponderano, Biella, Italy. 8. Department of General and Oncological Surgery, Ospedale Umberto I di Torino (Mauriziano), Corso Turati 62, 10128, Turin, Italy. 9. University of Turin, Department os Surgical Sciences, Unit of Digestive and Oncological Surgery 1U, Ospedale Molinette, AOU Città della Salute e della Scienza di Torino, Corso Bramante 88, 10126, Turin, Italy. 10. University of Turin. Department of Oncology, Surgical Oncology and Digestive Surgery Unit, San Luigi University Hospital (S.L.U.H.), Regione Gonzole 10, 10049, Orbassano, Turin, Italy. Electronic address: maurizio.degiuli@unito.it.
Abstract
BACKGROUND: While surgical treatment of Siewert I and III (S1,S3) Esophagogastric Junction (EGJ) cancer is codified, the efficay of transhiatal procedure with anastomosis in the lower mediastinum for Siewert II (S2) still remains a dibated topic. METHODS: This is a large multicenter retrospective study. The results of 598 consecutive patients submitted to resection with curative intent from January 2000 to January 2017 were reported. Clinical and oncological outcomes of different procedures performed in S2 tumor were analyzed to investigate the efficacy of transhiatal approach. RESULTS: The 5-year overall survival rate (OS) was poor (32%) for all Siewert types. The most performed operations in S2 cancer were proximal gastrectomy + transthoracic esophagectomy (TTE or Ivor-Lewis procedure, 60%), total gastrectomy + transhiatal distal esophagectomy with anastomosis in the chest (THE, 24%) and total gastrectomy + transthoracic esophagectomy (TGTTE, 15%). Cardiovascular and pulmonary complications were higher after TTE. On the contrary, surgical complications were significantly higher after THE. Postoperative mortality was similar. The distribution of TNM stages was different in the 3 types of procedures: patients submitted to THE had an earlier stage disease. With this bias, OS after THE was higher than after TTE but the difference was not significant (49.85% vs 28.42%, p = 0.0587). CONCLUSIONS: Despite a higher rate of postoperative surgical complications, OS after total gastrectomy and transhiatal distal esophagectomy was at least comparable to that of transthoracic approach in less advanced S2 tumors. Therefore, THE with anastomosis in the chest could be a treatmen option in earlier S2 tumors.
BACKGROUND: While surgical treatment of Siewert I and III (S1,S3) Esophagogastric Junction (EGJ) cancer is codified, the efficay of transhiatal procedure with anastomosis in the lower mediastinum for Siewert II (S2) still remains a dibated topic. METHODS: This is a large multicenter retrospective study. The results of 598 consecutive patients submitted to resection with curative intent from January 2000 to January 2017 were reported. Clinical and oncological outcomes of different procedures performed in S2 tumor were analyzed to investigate the efficacy of transhiatal approach. RESULTS: The 5-year overall survival rate (OS) was poor (32%) for all Siewert types. The most performed operations in S2 cancer were proximal gastrectomy + transthoracic esophagectomy (TTE or Ivor-Lewis procedure, 60%), total gastrectomy + transhiatal distal esophagectomy with anastomosis in the chest (THE, 24%) and total gastrectomy + transthoracic esophagectomy (TGTTE, 15%). Cardiovascular and pulmonary complications were higher after TTE. On the contrary, surgical complications were significantly higher after THE. Postoperative mortality was similar. The distribution of TNM stages was different in the 3 types of procedures: patients submitted to THE had an earlier stage disease. With this bias, OS after THE was higher than after TTE but the difference was not significant (49.85% vs 28.42%, p = 0.0587). CONCLUSIONS: Despite a higher rate of postoperative surgical complications, OS after total gastrectomy and transhiatal distal esophagectomy was at least comparable to that of transthoracic approach in less advanced S2 tumors. Therefore, THE with anastomosis in the chest could be a treatmen option in earlier S2 tumors.
Keywords:
Cardia cancer; Esophagogastric junction cancer; Surgery for Siewert type II cancer; Transhiatal distal esophagectomy for Siewert type II cancer; Treatment of Siewert type II cancer
Authors: Jiadi Xing; Maoxing Liu; Kai Xu; Pin Gao; Fei Tan; Zhendan Yao; Nan Zhang; Hong Yang; Chenghai Zhang; Ming Cui; Xiangqian Su Journal: Cancer Manag Res Date: 2020-11-19 Impact factor: 3.989