Laparoscopic and Conventional Limited Resection of the Gastroesophageal Junction with Isoperistaltic Jejunal Interposition

Abstract

Limited en-bloc resection of the gastroesophageal junction includes complete removal of the esophageal segment with metaplastic mucosa, the lower esophageal sphincter, and a part of the lesser gastric curvature and formation of a neofundus. Because even early adenocarcinomas of the distal esophagus (T1b) seed lymph node metastases in up to 20 % of patients, removal of the lymph nodes of the lesser curvature, the hepatic and splenic arteries, the celiac trunk, the para-aortal region, and the inferior mediastinum is an essential part of the operation.

In patients with early tumors, staged as uT1a or b on preoperative endosonography or severe dysplasia in the distal esophagus (Barrett’s esophagus), a limited resection of the proximal stomach, cardia, and distal esophagus with interposition of a pedicled isoperistaltic jejunal segment offers excellent functional and oncological results.

Due to recent technical developments, laparoscopic surgery has become quite common even in more complicated operation procedures. The benefit of reduced postoperative pain, faster recovery, and shorter hospitalization is evident. In patients presenting with early stages of distal esophageal carcinoma or benign diseases as mentioned above, laparoscopic resection of the gastroesophageal junction should be taken into consideration as the technical results concerning lymphadenectomy and anastomosis are equivalent to the open procedure.