Effect of Different Surgical Approaches on the Survival and Safety of Siewert Type II Esophagogastric Junction Adenocarcinoma: a Systematic Review and Meta-analysis

Overview

Journal BMC Cancer

Publisher Biomed Central

Specialty Oncology

Date 2023 Nov 22

PMID 37990193

Authors

Hongyang Zheng

Xingmei Yin

Tiewen Pan

Xiandong Tao

Xiaolin Xu

Zhenjia Li

Affiliations

Soon will be listed here.

Abstract

Background: Whether a transthoracic (TT) procedure by a thoracic surgeon or a transabdominal (TA) by a gastrointestinal surgeon is best for Siewert type II esophagogastric junction adenocarcinoma (EGJA) remains unknown. Survival and perioperative outcomes were compared between the two groups in this meta-analysis to clarify this argument.

Methods: We searched 7 databases for eligible studies comparing TT and TA procedures for Siewert type II EGJA. The final analyzed endpoints included intraoperative and hospitalization outcomes, recurrence, complication, and survival.

Results: Seventeen studies involving 10,756 patients met the inclusion criteria. The TA group had higher rates of overall survival (OS) (HR: 1.31 [1.20 ~ 1.44], p < 0.00001) and disease-free survival (DFS) (HR: 1.49 [1.24 ~ 1.79], p < 0.0001). The survival advantage of OSR and DFSR increased with time. Subgroup analysis of OS and DFS suggested that TA remained the preferred approach among all subgroups. More total/positive lymph nodes were retrieved, and fewer lymph node recurrences were found in the TA group. The analysis of perioperative outcomes revealed that the TA procedure was longer, had more intraoperative blood loss, and prolonged hospital stay. Similar R0 resection rates, as well as total recurrence, local recurrence, liver recurrence, peritoneal recurrence, lung recurrence, anastomosis recurrence and multiple recurrence rates, were found between the two groups. The safety analysis showed that the TT procedure led to more total complications, anastomotic leakages, cases of pneumonia, and cases of pleural effusion.

Conclusions: The TA procedure appeared to be a suitable choice for patients with Siewert type II EGJA because of its association with longer survival, fewer recurrences, and better safety.

Citing Articles

Comparison of proximal gastrectomy with tubular esophagogastric anastomosis and total gastrectomy with Roux-en-Y reconstruction in the treatment of adenocarcinoma of the esophagogastric junction of Siewert type II/III at stage II.

Zhang Z, Zhao T, Wang Y, Xue F, Pu Y, Du Q BMC Surg. 2024; 24(1):382.

PMID: 39614266 PMC: 11607818. DOI: 10.1186/s12893-024-02685-9.

References

Xing J, Liu M, Xu K, Gao P, Tan F, Yao Z . Short-Term and Long-Term Outcomes Following Transhiatal versus Right Thoracoabdominal Resection of Siewert Type II Adenocarcinoma of the Esophagogastric Junction. Cancer Manag Res. 2020; 12:11813-11821. PMC: 7683889. DOI: 10.2147/CMAR.S275569. View

Ovrebo K, Lie S, Laerum O, Svanes K, Viste A . Long-term survival from adenocarcinoma of the esophagus after transthoracic and transhiatal esophagectomy. World J Surg Oncol. 2012; 10:130. PMC: 3476969. DOI: 10.1186/1477-7819-10-130. View

Cao F, Hu C, Xu Z, Zhang Y, Huang L, Chen J . Current treatments and outlook in adenocarcinoma of the esophagogastric junction: a narrative review. Ann Transl Med. 2022; 10(6):377. PMC: 9011222. DOI: 10.21037/atm-22-1064. View

Greally M, Agarwal R, Ilson D . Optimal management of gastroesophageal junction cancer. Cancer. 2019; 125(12):1990-2001. PMC: 10172875. DOI: 10.1002/cncr.32066. View

Miyawaki Y, Sato H, Fujiwara N, Aoyama J, Oya S, Sugita H . Verification of oncological local control for hand-assisted laparoscopic abdominal lymph node dissection in esophageal cancer surgery: a propensity score-matched analysis. Esophagus. 2020; 18(2):187-194. DOI: 10.1007/s10388-020-00763-4. View

Chen Y, Zhao X, Xu R, Song X, Yang M, Zhou F . Transthoracic, thoracoabdominal, and transabdominal surgical approaches for gastric cardia adenocarcinomas: a survival evaluation based on a cohort of 7103 patients. World J Surg Oncol. 2022; 20(1):217. PMC: 9238161. DOI: 10.1186/s12957-022-02680-5. View

Voron T, Gronnier C, Pasquer A, Thereaux J, Gagniere J, Lebreton G . Adenocarcinoma of the oesophagogastric junction Siewert II: An oesophageal cancer better cured with total gastrectomy. Eur J Surg Oncol. 2019; 45(12):2473-2481. DOI: 10.1016/j.ejso.2019.07.022. View

Zhou J, Wang H, Niu Z, Chen D, Wang D, Lv L . Comparisons of Clinical Outcomes and Prognoses in Patients With Gastroesophageal Junction Adenocarcinoma, by Transthoracic and Transabdominal Hiatal Approaches: A Teaching Hospital Retrospective Cohort Study. Medicine (Baltimore). 2015; 94(50):e2277. PMC: 5058926. DOI: 10.1097/MD.0000000000002277. View

Tosolini C, Reim D, Schirren R, Feith M, Friess H, Novotny A . Influence of the surgical technique on survival in the treatment of carcinomas of the true cardia (Siewert Type II) - Right thoracoabdominal vs. transhiatal-abdominal approach. Eur J Surg Oncol. 2018; 45(3):416-424. DOI: 10.1016/j.ejso.2018.09.017. View

10.

Jadad A, Moore R, Carroll D, Jenkinson C, Reynolds D, Gavaghan D . Assessing the quality of reports of randomized clinical trials: is blinding necessary?. Control Clin Trials. 1996; 17(1):1-12. DOI: 10.1016/0197-2456(95)00134-4. View

11.

Guyatt G, Oxman A, Schunemann H, Tugwell P, Knottnerus A . GRADE guidelines: a new series of articles in the Journal of Clinical Epidemiology. J Clin Epidemiol. 2010; 64(4):380-2. DOI: 10.1016/j.jclinepi.2010.09.011. View

12.

Kurokawa Y, Sasako M, Sano T, Yoshikawa T, Iwasaki Y, Nashimoto A . Ten-year follow-up results of a randomized clinical trial comparing left thoracoabdominal and abdominal transhiatal approaches to total gastrectomy for adenocarcinoma of the oesophagogastric junction or gastric cardia. Br J Surg. 2015; 102(4):341-8. PMC: 5024022. DOI: 10.1002/bjs.9764. View

13.

Murakami K, Yoshida M, Uesato M, Toyozumi T, Isozaki T, Urahama R . Does thoracoscopic esophagectomy really reduce post-operative pneumonia in all cases?. Esophagus. 2021; 18(4):724-733. DOI: 10.1007/s10388-021-00855-9. View

14.

Graham A, Finley R, Clifton J, Evans K, Fradet G . Surgical management of adenocarcinoma of the cardia. Am J Surg. 1998; 175(5):418-21. DOI: 10.1016/S0002-9610(98)00040-3. View

15.

Wayman J, Dresner S, Raimes S, Griffin S . Transhiatal approach to total gastrectomy for adenocarcinoma of the gastric cardia. Br J Surg. 1999; 86(4):536-40. DOI: 10.1046/j.1365-2168.1999.01043.x. View

16.

Blank S, Schmidt T, Heger P, Strowitzki M, Sisic L, Heger U . Surgical strategies in true adenocarcinoma of the esophagogastric junction (AEG II): thoracoabdominal or abdominal approach?. Gastric Cancer. 2017; 21(2):303-314. DOI: 10.1007/s10120-017-0746-1. View

17.

Ajani J, DAmico T, Bentrem D, Chao J, Corvera C, Das P . Esophageal and Esophagogastric Junction Cancers, Version 2.2019, NCCN Clinical Practice Guidelines in Oncology. J Natl Compr Canc Netw. 2019; 17(7):855-883. DOI: 10.6004/jnccn.2019.0033. View

18.

Omloo J, Lagarde S, Hulscher J, Reitsma J, Fockens P, van Dekken H . Extended transthoracic resection compared with limited transhiatal resection for adenocarcinoma of the mid/distal esophagus: five-year survival of a randomized clinical trial. Ann Surg. 2007; 246(6):992-1000. DOI: 10.1097/SLA.0b013e31815c4037. View

19.

Siegel R, Miller K, Wagle N, Jemal A . Cancer statistics, 2023. CA Cancer J Clin. 2023; 73(1):17-48. DOI: 10.3322/caac.21763. View

20.

Siewert J, Stein H . Classification of adenocarcinoma of the oesophagogastric junction. Br J Surg. 1998; 85(11):1457-9. DOI: 10.1046/j.1365-2168.1998.00940.x. View