Ten‐year follow‐up results of a randomized clinical trial comparing left thoracoabdominal and abdominal transhiatal approaches to total gastrectomy for adenocarcinoma of the oesophagogastric junction or gastric cardia. Issue 4 (21st January 2015)

• Record Type: Journal Article
• Authors: Kurokawa, Y.; Sasako, M.; Sano, T.; Yoshikawa, T.; Iwasaki, Y.; Nashimoto, A.; Ito, S.; Kurita, A.; Mizusawa, J.; Nakamura, K.; for the Japan Clinical Oncology Group (JCOG9502)
• Is Part Of: British journal of surgery. Volume 102:Issue 4(2015:Apr.)
• Page Start: 341
• Page End: 348
• Publication Date: 2015-01-21
• Subjects: Surgery -- Periodicals; 617.005
• DOI: 10.1002/bjs.9764
• Languages: English
• ISSNs: 0007-1323

Abstract

<abstract abstract-type="main" id="bjs9764-abs-0001"> <title> <x xml:space="preserve">Abstract</x> </title> <sec id="bjs9764-sec-0001" sec-type="section"> <title>Background</title> <p id="bjs9764-para-0001">The optimal surgical approach for treatment of oesophagogastric junction (OGJ) cancer is controversial. A randomized clinical trial (JCOG9502) comparing transhiatal (TH) and left thoracoabdominal (LTA) approaches was stopped after the first interim analysis owing to limited efficacy for LTA resections. Complete 10‐year follow‐up data are now available.</p> </sec> <sec id="bjs9764-sec-0002" sec-type="section"> <title>Methods</title> <p id="bjs9764-para-0002">Patients with histologically proven adenocarcinoma of the OGJ or gastric cardia with oesophageal invasion of 3 cm or less were randomized to a TH or LTA approach. Both groups underwent total gastrectomy and splenectomy with D2 nodal dissection plus para‐aortic lymphadenectomy above the left renal vein. For LTA, a thorough mediastinal lymphadenectomy below the left inferior pulmonary vein was also mandatory. The primary endpoint was overall survival.</p> </sec> <sec id="bjs9764-sec-0003" sec-type="section"> <title>Results</title> <p id="bjs9764-para-0003">A total of 167 patients (82 TH, 85 LTA) were enrolled. The 10‐year overall survival rate was 37 (95 per cent c.i. 26 to 47) per cent for the TH approach and 24 (15 to 34) per cent for the LTA technique (<italic>P</italic> = 0·060). The hazard ratio for death was 1·42 (0·98 to 2·05) for the LTA technique. Subgroup analysis based on the Siewert classification indicated non‐significant survival advantages in favour of the TH approach.</p> </sec> <sec id="bjs9764-sec-0004" sec-type="section"> <title>Conclusion</title> <p id="bjs9764-para-0004">LTA resections should be avoided in the treatment of adenocarcinoma of the OGJ or gastric cardia. Registration number: NCT00149266 (<ext-link ext-link-type="uri" xlink:href="https://www.clinicaltrials.gov" xlink:type="simple" xmlns:xlink="http://www.w3.org/1999/xlink">https://www.clinicaltrials.gov</ext-link>).</p> </sec> </abstract>