Short-term outcomes after laparoscopic versus open transhiatal resection of Siewert type II adenocarcinoma of the esophagogastric junction.

Abstract

The potential advantages of laparoscopic surgery (LS) compared with open surgery (OS) for Siewert type II adenocarcinoma of the esophagogastric junction (AEG) have not been fully clarified. This study aimed to assess the feasibility and safety of the laparoscopic transhiatal approach for Siewert type II AEG, and compare the short-term outcomes of LS versus OS for Siewert type II AEG. We retrospectively analyzed 87 consecutive patients with Siewert type II AEG who underwent curative surgery from January 2008 to November 2016. Surgery-related short-term variables were analyzed in LS versus OS. Forty-five patients underwent LS, and 42 underwent OS. Compared with OS, LS was associated with significantly less intraoperative blood loss (11 vs. 408ml, p<0.001) and extended operation time (256 vs. 226min, p=0.001). There was no significant difference between LS and OS in postoperative hospitalization duration (9 vs. 10days, p=0.193) or rate of surgical morbidity (≥grade 3) for complications such as anastomotic leakage (4.4 vs. 4.8%, p=1.000), or pancreatic leakage (4.4 vs. 9.5%, p=0.423), and there were no pulmonary-associated complications in either group. There was no difference between groups in total number of harvested lymph nodes (24 vs. 29, p=0.502), but the number of harvested mediastinum LNs was larger in LS (2 vs. 1, p=0.002). There was no difference between groups in the length of the proximal margin (9 vs. 10mm, p=0.246), and the margins were negative in all cases in both groups. Laparoscopic transhiatal resection for Siewert type II AEG is technically challenging, but appears feasible and safe in technical or short-term oncological aspects when performed by an experienced surgical team. A large-scale prospective study is needed to evaluate long-term outcomes.