Abstract
BackgroundThe incidence of adenocarcinoma of the esophagogastric junction (AEG) is rising every year; however, the mode of operation for Siewert II AEG is still controversial. Accumulating evidence has shown that transabdominal surgery is better than transthoracic surgery for Siewert II AEG with esophageal invasion < 3 cm. In patients with obesity, a large tumor size, and high transection of the esophagus, the transabdominal esophageal hiatus approach for lower mediastinal lymph node dissection and posterior mediastinal anastomosis is difficult. Thus, total laparoscopic radical resection of Siewert II AEG is carried out through the left diaphragm and left chest auxiliary hole for the optimal surgical field of vision and space. In this prospective study, we assessed the feasibility of carrying out the procedure abdominally through the left diaphragm and auxiliary hole.MethodsTen patients with Siewert II AEG were recruited between April and June 2019. Siewert II AEG was treated by total laparoscopy through the left diaphragm and left chest auxiliary hole. Clinicopathological features, surgical data, and adverse events were collected and analyzed in this prospective study.ResultsThe average duration of the operation was 348 ± 37.52 min, lower mediastinal dissection took 20.6 min, the OrVil anastomosis time was 29.8 min, the time necessary to suture the seromuscular layer through the left thoracic auxiliary hole was 11 min, the safety margin was 3.2 cm, and the total number of lymph nodes dissected was 40.6. The number of lower mediastinal lymph nodes dissected was 6.2. The rate of lymph node metastasis in the N110 group was 9 ± 12.45%, and the average intraoperative blood loss was 170 ± 57.47 mL. No anastomotic leakage or anastomotic stricture occurred after the operation. The time of intestinal function recovery was 2 days, and the first time of enteral nutrition through a jejunal nutrition tube was 2.4 days. No tumor recurrence was found in 10 patients at 1 year postoperatively.ConclusionTotal laparoscopic radical resection through the left diaphragm and left thoracic auxiliary hole for Siewert II AEG patients is feasible and safe. Thus, it may be a good surgical alternative for patients with esophageal tumors invading less than 3 cm.Trial registrationChiCTR, ChiCTR2000034286. Registered 8 July 2020, http://www.chictr.org.cn/showproj.aspx?proj=55866.
Highlights
The incidence of adenocarcinoma of the esophagogastric junction (AEG) is rising every year; the mode of operation for Siewert II AEG is still controversial
For Siewert type II and type III patients with esophageal invasion < 3 cm, the transabdominal approach reduces the incidence of postoperative complications and improves the long-term prognosis [2]
Feasibility of transabdominal mediastinal lymph node dissection of Siewert II AEG At present, the classification of AEG is based on the Siewert classification proposed by the German scholar Siewert in 1987
Summary
The incidence of adenocarcinoma of the esophagogastric junction (AEG) is rising every year; the mode of operation for Siewert II AEG is still controversial. Approximately 80% of esophageal cancer cases in the world occur in underdeveloped areas, while 59% of new AEG patients reside in East/Southeast Asia [1]. Despite their rising incidence, there is still no consensus on the best surgical approach for these tumors due to narrow space, digestive tract reconstruction, anastomotic leakage, and pulmonary infection. The 10-year follow-up results were similar to those described above, with overall survival rates of 37% and 51% in the transthoracic and transabdominal groups, respectively (P=0.060). For Siewert type II and type III patients with esophageal invasion < 3 cm, the transabdominal approach reduces the incidence of postoperative complications and improves the long-term prognosis [2]
Sign-in/Register to view highlights & summary Sign-in/Register to access full text options 
Free) 
Talk to us
Join us for a 30 min session where you can share your feedback and ask us any queries you have
Schedule a call
