Thoracoabdominal versus transhiatal surgical approaches for adenocarcinoma of the esophagogastric junction—a systematic review and meta-analysis
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The aim of this systematic review and meta-analysis was to compare the oncological and perioperative outcomes of transhiatally extended gastrectomy (TEG) and thoracoabdominal esophagectomy (TAE) for therapy of adenocarcinomas of the esophagogastric junction (AEG) with focus on AEG type II, as the optimal approach for these tumors is still unclear.
MEDLINE, EMBASE, and the Cochrane Library (CENTRAL) were searched until July 24, 2018. Studies comparing TAE and TEG for surgical treatment of AEG type tumors have been included. Patient’s baseline and perioperative data have been extracted and meta-analyses have been conducted for the outcomes: number of dissected lymph nodes, R0-resection rate, anastomotic leak rate, postoperative morbidity, and 30-day mortality.
Of 6709 articles identified, 8 studies have been included for further analysis. One thousand thirty-four patients underwent TAE, and 1177 patients TEG. No differences were found between the approaches in regard to number of dissected lymph nodes (MD − 0.96; 95% CI − 3.07 to 1.15; p = 0.37), R0-resection rates (OR 0.97; 95% CI 0.57 to 1.63; p = 0.90), anastomotic leak rates (OR 1.13; 95% CI 0.69 to 1.86; p = 0.63), and 30-day mortality (OR 1.53; 95% CI 0.90 to 2.61; p = 0.11). However, a higher rate of postoperative morbidity was found after TAE (OR 1.55; 95% CI 1.12 to 2.14; p = 0.008).
The optimal approach to surgical therapy of AEG II still remains unclear. This study identified a significantly higher rate of postoperative morbidity after TAE at comparable surgical outcomes. Due to major limitations concerning the quality of included studies, current data strongly mandates a properly designed randomized controlled trial to identify the optimal surgical approach for AEG type II tumors.
KeywordsEsophageal adenocarcinoma Esophagogastric junction cancer Esophageal and gastric surgery Gastrectomy Esophagectomy
PH, SB, HN, ALM, and TS are responsible for conception and design of the study. PH, SB, KG, ALM, and TS performed the acquisition and analysis of the data, and drafted the manuscript. HN, MKD, and AU offered substantial contributions to interpretation of the data and critically revised the manuscript. All authors gave their final approval of this version of the manuscript and are accountable for all aspects of the work.
Compliance with ethical standards
No funding source is available for this study. However, the resources and facilities of the University of Heidelberg were used in conducting this study.
The authors declare no conflict of interest.
This article does not contain any studies with human participants or animals performed by any of the authors.
- 2.Robert-Koch-Institut, B., Germany (2015) Krebs in Deutschland. [cited 2016; Available from: http://www.krebsdaten.de/Krebs/DE/Content/Publikationen/Krebs_in_Deutschland/kid_2015/kid_2015_c15_speiseroehre.pdf;jsessionid=B568EB26C187B3F599368AF9005A1D43.2_cid390?__blob=publicationFile. Accessed Dec 18 2018
- 3.Lutz MP, Zalcberg JR, Ducreux M, Ajani JA, Allum W, Aust D, Bang YJ, Cascinu S, Hölscher A, Jankowski J, Jansen EP, Kisslich R, Lordick F, Mariette C, Moehler M, Oyama T, Roth A, Rueschoff J, Ruhstaller T, Seruca R, Stahl M, Sterzing F, van Cutsem E, van der Gaast A, van Lanschot J, Ychou M, Otto F, First St Gallen EORTC Gastrointestinal Cancer Conference 2012 Expert Panel (2012) Highlights of the EORTC St. Gallen International Expert Consensus on the primary therapy of gastric, gastroesophageal and oesophageal cancer—differential treatment strategies for subtypes of early gastroesophageal cancer. Eur J Cancer 48(16):2941–2953CrossRefGoogle Scholar
- 5.van Hagen P, Hulshof MC, van Lanschot J, Steyerberg EW, van Berge Henegouwen M, Wijnhoven BP, Richel DJ, Nieuwenhuijzen GA, Hospers GA, Bonenkamp JJ, Cuesta MA, Blaisse RJ, Busch OR, ten Kate F, Creemers GJ, Punt CJ, Plukker JT, Verheul HM, Spillenaar Bilgen EJ, van Dekken H, van der Sangen M, Rozema T, Biermann K, Beukema JC, Piet AH, van Rij C, Reinders JG, Tilanus HW, van der Gaast A, CROSS Group (2012) Preoperative chemoradiotherapy for esophageal or junctional cancer. N Engl J Med 366(22):2074–2084CrossRefGoogle Scholar
- 7.Hermanek P, Sobin LH (2002) TNM classification of malignant tumors. Springer, New YorkGoogle Scholar
- 8.Cancer., A.J.C.o (2002) AJCC cancer staging manual, 6th edn. Springer, New YorkGoogle Scholar
- 12.Sasako M, Sano T, Yamamoto S, Sairenji M, Arai K, Kinoshita T, Nashimoto A, Hiratsuka M, Japan Clinical Oncology Group (JCOG9502) (2006) Left thoracoabdominal approach versus abdominal-transhiatal approach for gastric cancer of the cardia or subcardia: a randomised controlled trial. Lancet Oncol 7(8):644–651CrossRefGoogle Scholar
- 13.Ott K, Bader FG, Lordick F, Feith M, Bartels H, Siewert JR (2009) Surgical factors influence the outcome after Ivor-Lewis esophagectomy with intrathoracic anastomosis for adenocarcinoma of the esophagogastric junction: a consecutive series of 240 patients at an experienced center. Ann Surg Oncol 16(4):1017–1025CrossRefGoogle Scholar
- 20.Leitlinienprogramm Onkologie (Deutsche Krebsgesellschaft, D.K., AWMF) (2015) S3-Leitlinie Diagnostik und Therapie der Plattenepithelkarzinome und Adenokarzinome des Ösophagus, Langversion 1.0, 2015, AWMF Registernummer: 021/023OL. Available from: http://leitlinienprogramm-onkologie.de/Leitlinien.7.0.html. Accessed Dec 18 2018
- 24.Kurokawa Y, Sasako M, Sano T, Yoshikawa T, Iwasaki Y, Nashimoto A, Ito S, Kurita A, Mizusawa J, Nakamura K, for the Japan Clinical Oncology Group (JCOG9502) (2015) 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 102(4):341–348CrossRefGoogle Scholar
- 27.Schumacher G, Schmidt SC, Schlechtweg N, Roesch T, Sacchi M, von Dossow V, Chopra SS, Pratschke J, Zhukova J, Stieler J, Thuss-Patience P, Neuhaus P (2009) Surgical results of patients after esophageal resection or extended gastrectomy for cancer of the esophagogastric junction. Dis Esophagus 22(5):422–426CrossRefGoogle Scholar
- 30.Blank S, Schmidt T, Heger P, Strowitzki MJ, Sisic L, Heger U, Nienhueser H, Haag GM, Bruckner T, Mihaljevic AL, Ott K, Büchler MW, Ulrich A. (2018) Surgical strategies in true adenocarcinoma of the esophagogastric junction (AEG II): thoracoabdominal or abdominal approach? Gastric Cancer 21(2):303–314Google Scholar
- 35.Fuchs H et al (2015) Long-term quality of life after surgery for adenocarcinoma of the esophagogastric junction: extended gastrectomy or transthoracic esophagectomy? Gastric CancerGoogle Scholar
- 39.Omloo JM et al (2007) 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 246:992–1000; discussion 1000–1. https://doi.org/10.1097/SLA.0b013e31815c4037 CrossRefPubMedGoogle Scholar