Transthoracically or Transabdominally: How to Approach Adenocarcinoma of the Distal Esophagus and Cardia. A Meta-Analysis. Issue 4 (July 2016)

• Record Type: Journal Article
• Authors: Aurello, Paolo; Magistri, Paolo; Berardi, Giammauro; Petrucciani, Niccolò; Sirimarco, Dario; Antolino, Laura; Nigri, Giuseppe; D'Angelo, Francesco; Ramacciato, Giovanni
• Is Part Of: Tumori. Volume 102:Issue 4(2016)
• Page Start: 352
• Page End: 360
• Publication Date: 2016-07
• Subjects: Adenocarcinoma -- Esophagectomy -- Esophagogastric junction -- Siewert -- Transthoracic -- Transhiatal; Cancer -- Periodicals; 616.994
• DOI: 10.5301/tj.5000517
• Languages: English
• ISSNs: 0300-8916

Abstract

Esophageal carcinoma is the eighth most frequent cancer worldwide and the sixth cancer-related cause of death. Here we propose a new meta-analysis to identify the most appropriate approach for resectable adenocarcinoma of the distal esophagus and cardia (Siewert 1-2). A systematic literature search was performed independently by 2 of the manuscript's authors using PubMed, EMBASE, Scopus and the Cochrane Library Central. The following criteria were set for inclusion in this meta-analysis: 1) studies comparing transthoracic esophagectomy and transhiatal esophagectomy for adenocarcinoma of the esophagus; 2) studies reporting at least 1 perioperative outcome; and 3) if more than 1 study was reported by the same institute, only the most recent or the highest quality study was included. A total of 6 articles dated between 1996 and 2012 fulfilled the selection criteria and were therefore included in this meta-analysis; this pool of articles consisted of 2 prospective and 4 retrospective studies. A statistically significant difference favoring the transthoracic procedure was noted regarding the number of retrieved lymph nodes, 5-year disease-free survival rate and 5-year overall survival rate (p = 0.001, p = 0.05 and p = 0.03, respectively). In conclusion, transthoracic esophagectomy for adenocarcinoma of the distal esophagus and esophagogastric junction (Siewert 1-2) appears to be superior to the transhiatal approach in terms of oncological outcomes.