Thibault Voron1, Caroline Gronnier2, Arnaud Pasquer3, Jeremie Thereaux4, Johan Gagniere5, Gil Lebreton6, Bernard Meunier7, Denis Collet2, Guillaume Piessen8, François Paye9. 1. Sorbonne Université, Department of Digestive Surgery, Saint Antoine Hospital, AP-HP, 75012, Paris, France. 2. Department of Digestive Surgery, Haut-Lévêque University Hospital, Bordeaux, France. 3. Department of Digestive Surgery, Edouard Herriot University Hospital, Lyon, France. 4. Department of Digestive Surgery, Cavale Blanche University Hospital, Brest, France. 5. Estaing University Hospital, Clermont-Ferrand, France. 6. Côte de Nacre University Hospital, Caen, France. 7. Department of Digestive and Hepatobiliary Surgery, Pontchaillou University Hospital, Rennes, France. 8. Department of Digestive and Oncological Surgery, Claude Huriez University Hospital, Lille, France; North of France University, Lille, France. 9. Sorbonne Université, Department of Digestive Surgery, Saint Antoine Hospital, AP-HP, 75012, Paris, France. Electronic address: francois.paye@aphp.fr.
Abstract
INTRODUCTION: Type II AEG is now considered as oesophageal cancer in the seventh and eighth edition of TNM classification but optimal surgical approach for these tumors remains debated. The objective of the study is to assess and compare surgical and oncological outcomes of two surgical approaches: superior polar oesogastrectomy (SPO) or total gastrectomy (TG) in patients with type II adenocarcinoma of the oesophagogastric junction (AEG). MATERIAL AND METHODS: 183 patients with type II AEG treated from 1997 to 2010 in 21 French centers by SPO or TG were included in a multicenter retrospective study. The surgical and oncological outcomes were compared between these two surgical approaches. RESULTS: A TG was performed in 64 (35%) patients whereas 119 (65%) patients were treated by SPO with transthoracic approach in 100 of them (83.2%) and transhiatal approach with cervicotomy in 19 (16.8%). Surgical outcomes were comparable between the two approaches with a postoperative mortality rate of 4.9% and a severe operative morbidity rate within 30 days of 15.3%. Median survival in patients operated on by TG was of 46 months compared to 27 months in patients treated by SPO (p = 0.118). At multivariate analysis, TG appears to be an independent good prognostic factor compared to SPO (HR = 1.847; p = 0.008). However, TG was also associated with a higher rate of incomplete resection, (12.5% vs 5.9%; p = 0.120). CONCLUSION: When TG allows obtaining tumor-free resection margins, this approach should be preferred to SPO.
INTRODUCTION: Type II AEG is now considered as oesophageal cancer in the seventh and eighth edition of TNM classification but optimal surgical approach for these tumors remains debated. The objective of the study is to assess and compare surgical and oncological outcomes of two surgical approaches: superior polar oesogastrectomy (SPO) or total gastrectomy (TG) in patients with type II adenocarcinoma of the oesophagogastric junction (AEG). MATERIAL AND METHODS: 183 patients with type II AEG treated from 1997 to 2010 in 21 French centers by SPO or TG were included in a multicenter retrospective study. The surgical and oncological outcomes were compared between these two surgical approaches. RESULTS: A TG was performed in 64 (35%) patients whereas 119 (65%) patients were treated by SPO with transthoracic approach in 100 of them (83.2%) and transhiatal approach with cervicotomy in 19 (16.8%). Surgical outcomes were comparable between the two approaches with a postoperative mortality rate of 4.9% and a severe operative morbidity rate within 30 days of 15.3%. Median survival in patients operated on by TG was of 46 months compared to 27 months in patients treated by SPO (p = 0.118). At multivariate analysis, TG appears to be an independent good prognostic factor compared to SPO (HR = 1.847; p = 0.008). However, TG was also associated with a higher rate of incomplete resection, (12.5% vs 5.9%; p = 0.120). CONCLUSION: When TG allows obtaining tumor-free resection margins, this approach should be preferred to SPO.
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