Transhiatal distal esophagectomy for Siewert type II cardia cancer can be a treatment option in selected patients. Issue 10 (October 2019)

• Record Type: Journal Article
• Authors: Reddavid, Rossella; Strignano, Paolo; Sofia, Silvia; Evangelista, Andrea; Deiro, Giacomo; Cannata, Gaspare; Chiaro, Paolo; Maiello, Fabio; Mineccia, Michela; Ferrero, Alessandro; Leli, Renzo; Gentilli, Sergio; Polastri, Roberto; Borghi, Felice; Camandona, Michele; Romagnoli, Renato; Morino, Mario; Degiuli, Maurizio
• Is Part Of: European journal of surgical oncology. Volume 45:Issue 10(2019)
• Page Start: 1943
• Page End: 1949
• Publication Date: 2019-10
• Subjects: Esophagogastric junction cancer -- Cardia cancer -- Treatment of Siewert type II cancer -- Surgery for Siewert type II cancer -- Transhiatal distal esophagectomy for Siewert type II cancer; Oncology -- Periodicals; Cancer -- Surgery -- Periodicals; Medical Oncology -- Periodicals; Neoplasms -- surgery -- Periodicals; Cancer -- Chirurgie -- Périodiques; Cancérologie -- Périodiques; Oncologie; Chirurgie (geneeskunde); Electronic journals; Electronic journals -- Sciences; Electronic journals -- Medicine; Electronic journals; 616.994059005
• DOI: 10.1016/j.ejso.2019.04.001
• Languages: English
• ISSNs: 0748-7983

Abstract

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.