Abstract
BackgroundAlthough the morbidity of gastric cancer has decreased, the incidence of adenocarcinoma of the esophagogastric junction (AEG) is increasing. Furthermore, no consensus exists on which surgical approach should be applied for Siewert type II AEG. The purpose of our study was to evaluate the technical safety and feasibility of a new surgical approach.MethodsSixty patients with Siewert type II AEG underwent laparoscopic total gastrectomy with the total laparoscopic transabdominal-transdiaphragmatic (TLTT) approach, which needs an incision in the diaphragm.ResultsThe median operative time, reconstruction time, and estimated blood loss were 214.8 ± 41.6 min, 29.40 ± 7.1 min, and 209.0 ± 110.3 ml, respectively. All of the patients had negative surgical margins.ConclusionThere were no intraoperative complications or conversions to open surgery. Our surgical procedure provides a unique option for the safe application of laparoscopic lower mediastinal lymph node dissection and gastrointestinal reconstruction.Trial registrationChinese Clinical Trial Registry, ChiCTR1800014336. Registered on 31 December 2017 - Prospectively registered, http://www.chictr.org.cn/edit.aspx?pid=23111&htm=4.
Highlights
The morbidity of gastric cancer has decreased, the incidence of adenocarcinoma of the esophagogastric junction (AEG) is increasing
Adenocarcinoma of the esophagogastric junction (AEG) refers to adenocarcinoma that straddles the area of the esophagogastric junction (EGJ), including the distal esophagus and the proximal stomach, and is considered to have a high morbidity and low survival [1]
Based on a retrospective review of 1602 consecutive resected patients [6], esophagectomy should be used for the treatment of type I tumors, while extended total gastrectomy should be adopted for the treatment of type II and type III tumors
Summary
The morbidity of gastric cancer has decreased, the incidence of adenocarcinoma of the esophagogastric junction (AEG) is increasing. No consensus exists on which surgical approach should be applied for Siewert type II AEG. The incidence of AEG has increased rapidly in both Asian and Western countries [2]. Western and Asian authors have reached a general agreement about the optimal surgical method for Siewert type I and III tumors, which is to apply total gastrectomy with distal esophagectomy with lower mediastinal lymphadenectomy and esophagectomy with a two-field Ivor Lewis operation via an exclusive abdominal approach. Subtotal esophagectomy with proximal gastrectomy through the transhiatal or transthoracic method or total gastrectomy with partial esophagectomy through a transhiatal approach is usually chosen. Due to the small sample size, the safety and effectiveness of this procedure still need to be further studied
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