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Annals of Surgical Oncology

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01-02-2020 | Esophagus Resection | Gastrointestinal Oncology

For Gastroesophageal Junction Cancers, Does an “Esophageal” or “Gastric” Surgical Approach Offer Better Perioperative and Oncologic Outcomes?

Authors: Jennifer Tseng, MD, Mitchell C. Posner, MD

Published in: Annals of Surgical Oncology | Issue 2/2020

Abstract

Background

The optimal surgical approach to the resection of gastoesophageal junction cancer is unknown. A comprehensive literature search was conducted to further compare the esophageal and gastric approaches to gastroesophageal junction cancer.

Methods

A systematic review of the literature from January 1990 to May 2018 was performed to determine whether an esophageal or gastric surgical approach offers better perioperative and oncologic outcomes.

Results

A total of 179 abstracts were identified and after excluding publications for non-English language, primary focus on neoadjuvant and/or adjuvant treatment, lack of comparison of surgical approaches or not addressing morbidity, mortality, or survival-related outcomes, a total of 14 nonrandomized, comparative studies were reviewed in detail.

Conclusions

The proximal and distant extent of the tumor based on Siewert type classification greatly influences choice of operation. Overall survival rates and surgical outcomes are comparable, and surgical approach should be dictated by patient factors.

Rice TW, Ishwaran H, Ferguson MK, et al. Cancer of the esophagus and esophagogastric junction: an eighth edition staging primer. J Thorac Oncol. 2017;12(1): 36–42.CrossRef

Rice TW, Blackstone EH, Rusch VW. 7th edition of the AJCC cancer staging manual: esophagus and esophagogastric junction. Ann Surg Oncol. 2010;17(7):1721–4. https://doi.org/10.1245/s10434-010-1024-1.CrossRefPubMed

Siewert JR, Stein HJ. Classification of adenocarcinoma of the oesophagogastric junction. Br J Surg. 1998;85(11):1457–9. https://doi.org/10.1046/j.1365-2168.1998.00940.x.CrossRefPubMed

Lewis I. The surgical treatment of carcinoma of the oesophagus; with special reference to a new operation for growths of the middle third. Br J Surg. 1946; 34(133):18–31.CrossRef

Wayman J, Dresner SM, Raimes SA, Griffin SM. Transhiatal approach to total gastrectomy for adenocarcinoma of the gastric cardia. Br J Surg. 1999;86(4):536–40. https://doi.org/10.1046/j.1365-2168.1999.01043.x.CrossRefPubMed

Barbour AP, Rizk NP, Gonen M, Tang L, Bains MS, Rusch VW, et al. Adenocarcinoma of the gastroesophageal junction: influence of esophageal resection margin and operative approach on outcome. Ann Surg. 2007;246(1):1–8. https://doi.org/10.1097/01.sla.0000255563.65157.d2.CrossRefPubMedPubMedCentral

Siewert JR, Feith M, Werner M, Stein HJ. Adenocarcinoma of the esophagogastric junction. Results of surgical therapy based on anatomical/topographic classification of 1,002 consecutive patients. Ann Surg. 2000; 232:353–61.CrossRef

Wong J, Law S. Two approaches to cancer of the cardia. Lancet Oncol. 2006;7(8):613–5. https://doi.org/10.1016/s1470-2045(06)70770-7.CrossRefPubMed

Parry K, Haverkamp L, Bruijnen RC, Siersema PD, Ruurda JP, van Hillegersberg R. Surgical treatment of adenocarcinomas of the gastro-esophageal junction. Ann Surg Oncol. 2015;22(2):597–603. https://doi.org/10.1245/s10434-014-4047-1.CrossRefPubMed

10.

Reeh M, Mina S, Bockhorn M, Kutup A, Nentwich MF, Marx A, et al. Staging and outcome depending on surgical treatment in adenocarcinomas of the oesophagogastric junction. Br J Surg. 2012;99(10):1406–14. https://doi.org/10.1002/bjs.8884.CrossRefPubMed

11.

Mariette C, Castel B, Toursel H, Fabre S, Balon JM, Triboulet JP. Surgical management of and long-term survival after adenocarcinoma of the cardia. Br J Surg. 2002;89(9):1156–63. https://doi.org/10.1046/j.1365-2168.2002.02185.x.CrossRefPubMed

12.

Ito H, Clancy TE, Osteen RT, Swanson RS, Bueno R, Sugarbaker DJ, et al. Adenocarcinoma of the gastric cardia: what is the optimal surgical approach? J Am Coll Surg. 2004;199(6):880–6. https://doi.org/10.1016/j.jamcollsurg.2004.08.015.CrossRefPubMed

13.

Ulrich B, Zahedi A. Technical aspects and results of the transhiatal resection in adenocarcinomas of the gastroesophageal junction. Dis Esophagus. 2001;14(2):115–9.CrossRef

14.

Kauppila JH, Wahlin K, Lagergren J. Gastrectomy compared to oesophagectomy for Siewert II and III gastro-oesophageal junctional cancer in relation to resection margins, lymphadenectomy and survival. Sci Rep. 2017;7(1):17783.CrossRef

15.

Blank S, Schmidt T, Heger P, et al. Surgical strategies in true adenocarcinoma of the esophagogastric junction (AEG II): thoracoabdominal or abdominal approach? Gastric Cancer. 2018;21(2):303–314.CrossRef

16.

Martin JT, Mahan A, Zwischenberger JB, et al. Should gastric cardia cancers be treated with esophagectomy or total gastrectomy? A comprehensive analysis of 4,996 NSQIP/SEER patients. J Am Coll Surg. 2015;220(4):510–20. https://doi.org/10.1016/j.jamcollsurg.2014.12.024.CrossRefPubMed

17.

Day RW, Badgwell BD, Fournier KF, et al. Defining the impact of surgical approach on perioperative outcomes for patients with gastric cardia malignancy. J Gastrointest Surg. 2016;20:146. https://doi.org/10.1007/s11605-015-2949-2.CrossRefPubMed

18.

Schumacher G, Schmidt SC, Schlechtweg N, Roesch T, Sacchi M, von Dossow V, et al. Surgical results of patients after esophageal resection or extended gastrectomy for cancer of the esophagogastric junction. Dis Esophagus. 2009;22(5):422–6. https://doi.org/10.1111/j.1442-2050.2008.00923.x.CrossRefPubMed

19.

Karanicolas PJ, Graham D, Gonen M, Strong VE, Brennan MF, Coit DG. Quality of life after gastrectomy for adenocarcinoma: a prospective cohort study. Ann Surg. 2013;257(6):1039–46. https://doi.org/10.1097/sla.0b013e31828c4a19.CrossRefPubMedPubMedCentral

20.

Barbour AP, Lagergren P, Hughes R, Alderson D, Barham CP, Blazeby JM. Health-related quality of life among patients with adenocarcinoma of the gastro-oesophageal junction treated by gastrectomy or oesophagectomy. Br J Surg. 2008;95(1):80–4. https://doi.org/10.1002/bjs.5912.CrossRefPubMed

21.

Spector NM, Hicks FD, Pickleman J. Quality of life and symptoms after surgery for gastroesophageal cancer: a pilot study. Gastroenterol Nurs. 2002;25(3):120–5.CrossRef

22.

Fuchs H, Hölscher AH, Leers J, et al. Long-term quality of life after surgery for adenocarcinoma of the esophagogastric junction: extended gastrectomy or transthoracic esophagectomy? Gastric Cancer. 2016; 19(1):312–7. https://doi.org/10.1007/s10120-015-0466-3.CrossRefPubMed

23.

Kauppila JH, Ringborg C, Johar A, et al. Health-related quality of life after gastrectomy, esophagectomy, and combined esophagogastrectomy for gastroesophageal junction adenocarcinoma. Gastric Cancer. 2018; 21(3):533–541.CrossRef

24.

Sasako M, Sano T, Yamamoto S, et al. Japan clinical oncology group (JCOG9502). Left thoracoabdominal approach versus abdominal-transhiatal approach for gastric cancer of the cardia or subcardia: a randomised controlled trial. Lancet Oncol. 2006;7(8):644–51.CrossRef

25.

Haveramp L, Ruurda JP, van Leeuwen MS, et al. Systematic review of the surgical strategies of adenocaricnomas of the gastroesophageal junction. Surg Oncol. 2014;23(4):22–8.

26.

National Comprehensive Cancer Network. Esophageal and esophagogastric junction cancers (Version 1.2019). https://www.nccn.org/professionals/physician_gls/pdf/esophageal.pdf. Accessed 1 April 2019.

27.

National Comprehensive Cancer Network. Gastric Cancer (Version 1.2019). https://www.nccn.org/professionals/physician_gls/pdf/gastric.pdf. Accessed 1 April 2019.

28.

Ellis FH, Jr. Treatment of carcinoma of the esophagus or cardia. Mayo Clin Proc. 1989;64(8):945–55.CrossRef

29.

Chu KM, Law SY, Fok M, et al. A prospective randomized comparison of transhiatal and transthoracic resection for lower-third esophageal carcinoma. Am J Surg. 1997;174(3):320–4.CrossRef

30.

Hulscher JB, van Sandick JW, de Boer AG, Wijnhoven BP, Tijssen JG, Fockens P, et al. Extended transthoracic resection compared with limited transhiatal resection for adenocarcinoma of the esophagus. N Engl J Med. 2002;347(21):1662–9. https://doi.org/10.1056/nejmoa022343.CrossRefPubMed

Title: For Gastroesophageal Junction Cancers, Does an “Esophageal” or “Gastric” Surgical Approach Offer Better Perioperative and Oncologic Outcomes?
Authors: Jennifer Tseng, MD
Mitchell C. Posner, MD
Publication date: 01-02-2020
Publisher: Springer International Publishing
Keywords: Esophagus Resection
Gastrectomy
Esophagus Resection
Gastrectomy
Published in: Annals of Surgical Oncology / Issue 2/2020
Print ISSN: 1068-9265
Electronic ISSN: 1534-4681
DOI: https://doi.org/10.1245/s10434-019-07732-x

At a glance: The STEP trials

Springer Medicine

For Gastroesophageal Junction Cancers, Does an “Esophageal” or “Gastric” Surgical Approach Offer Better Perioperative and Oncologic Outcomes?

Abstract

Background

Methods

Results

Conclusions

At a glance: The STEP trials

Springer Medicine

Abstract

Background

Methods

Results

Conclusions

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