Surgical approach for Siewert type II adenocarcinoma of the esophagogastric junction: transthoracic or transabdominal? A retrospective analysis in a single center

Abstract

Background: Adenocarcinoma of the esophagogastric junction (AEG) is a special type of challenging carcinoma between esophageal and gastric cancer with controversy in the diagnosis, treatment and prognosis. The Siewert classification is widely accepted by the majority of scholars at home and abroad, in which, type I and type III AEG are usually treated based on the guidelines for esophageal cancer and gastric cancer, respectively. However, the surgical approach topatients with type II AEG still remains controversial. In this study, we intended to realize the different surgical approach for Siewert type II AEG treatment by analyzing the data retrospectively. Methods: Patients with Siewert type II AEG were collected in Guangdong General Hospital from 2004 to 2014. We compared the clinicopathological outcome and prognosis in transthoracic(TT) and transabdominal(TA) approach. Results: A total of 158 patients with Siewert type II AEG were enrolled. Overall medium survival was 52 months and the 5-year survival rate was 39.1%. The 5-year survival rate was comparable between TT and TA group (35.1% vs 43.2%,p>0.05), while more lymph nodes were dissected in TA group (23.7±0.2 vs 18.1±0.3, p<0.05), with less postoperative complications (14.3%vs28.4%,p<0.05) and shorten hospital stay(12±4 d vs 15±7 d, p<0.05). Conclusion: For Siewert type II AEG patients, there is no significant difference in survival outcome as treated with TT or TA approach. However, fewer lymph nodes dissection number was conducted in transthoracic group, with a higher incidence of postoperative complication. Therefore, we consider that transabdominal approach is more suitable for patients with Siewert type II AEG to achieve an optimal extent of lymph node dissection, and reduce the incidence of complication, shorten hospital stay and promote the recovery. But our study is only a single-center, retrospective, small sample clinical study that represents our previous clinical treatment experience and we need more multi-center, prospective, and a large sample of clinical studies to be validated.