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Journal of Gastrointestinal Surgery
Published in: Journal of Gastrointestinal Surgery 7/2023

03-04-2023 | Esophagus Resection | Original Article

Oesophagectomy or Total Gastrectomy for the Management of Siewert II Gastroesophageal Junction Cancer: a Systematic Review and Meta-analysis

Authors: James Walmsley, Arun Ariyarathenam, Richard Berrisford, Lee Humphreys, Grant Sanders, Ji Chung Tham, Tim Wheatley, David S.Y. Chan

Published in: Journal of Gastrointestinal Surgery | Issue 7/2023

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Abstract

Background

There is no consensus on the ideal surgical management of patients with Siewert type II gastroesophageal junctional (GEJ) cancers. Due to its anatomical location, total gastrectomy and oesophagectomy are widely used methods of resection. The aim of this study was to determine the optimal surgical treatment of these patients.

Method

A systematic search of PubMed, Medline and Cochrane libraries was conducted for literature published between 2000 and 2022. Studies directly comparing oesophagectomy to gastrectomy for Siewert type II tumours were included. Outcome measures included rates of anastomotic leak, 30-day mortality, R0 resection and 5-year survival. Statistical analysis was performed using Review Manager 5.4.

Results

Eleven studies involving 18,585 patients undergoing either oesophagectomy (n = 8618) or total gastrectomy (n = 9967) for Siewert type II GEJ cancer were included. There were no significant differences between the rates of anastomotic leak (OR 0.91, CI 0.59–1.40, p = 0.66) and R0 resection (OR 1.51, CI 0.93–2.42, p = 0.09). Patients undergoing total gastrectomy had a lower 30-day mortality (OR 0.66, CI 0.45–0.95, p = 0.03) and a greater 5-year overall survival (OR 1.49, CI 1.34–1.67, p < 0.001) compared to patients undergoing oesophagectomy. These differences were not statistically significant after excluding two large studies, which accounted for the majority of the total population in the analysis.

Conclusion

These results suggest that total gastrectomy results in lower 30-day mortality and improved overall survival in patients with Siewert type II GEJ cancer. However, interpretation of these results may be biased by the effect of two large studies.
Appendix
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Literature
1.
2.
3.
Oo AM, Ahmed S. Overview of gastroesophageal junction cancers. Mini-invasive Surgery 2019;3:13.
4.
Kubo A, Corley DA. Body mass index and adenocarcinomas of the esophagus or gastric cardia: a systematic review and meta-analysis. Cancer Epidemiol Biomark Prev 2006;15(5):872-8.
5.
Siewert JR, Stein HJ. Carcinoma of the gastroesophageal junction - classification, pathology and extent of resection. Dis Esophagus 1996;9(3):173-82.
6.
Siewert JR, Stein HJ. Classification of adenocarcinoma of the oesophagogastric junction. Br J Surg. 2003;85(11):1457-9.
7.
Feenstra ML, Ten Hoope W, Hermanides J, Gisbertz SS, Hollmann MW, van Berge Henegouwen MI, et al. Optimal Perioperative Pain Management in Esophageal Surgery: An Evaluation of Paravertebral Analgesia. Ann Surg Oncol. 2021;28(11):6321-8.PubMedPubMedCentral
8.
Benedix F, Willems T, Kropf S, Schubert D, Stübs P, Wolff S. Risk factors for delayed gastric emptying after esophagectomy. Langenbeck's Arch Surg 2017;402(3):547-54.
9.
Mine S, Sano T, Tsutsumi K, Murakami Y, Ehara K, Saka M, et al. Large-scale investigation into dumping syndrome after gastrectomy for gastric cancer. J Am Coll Surg 2010;211(5):628-36.PubMed
10.
Li Z, Jiang H, Chen J, Jiang Y, Liu Y, Xu L. Comparison of Efficacy Between Transabdominal and Transthoracic Surgical Approaches for Siewert Type II Adenocarcinoma of the Esophagogastric Junction: A Systematic Review and Meta-Analysis. Front Oncol 2022;12:813242.PubMedPubMedCentral
11.
Moher D, Shamseer L, Clarke M, Ghersi D, Liberati A, Petticrew M, et al. Preferred reporting items for systematic review and meta-analysis protocols (PRISMA-P) 2015 statement. Syst Rev 2015;4(1):1.PubMedPubMedCentral
12.
Wells G, Shea B, O'Connell J. The Newcastle-Ottawa Scale (NOS) for Assessing The Quality of Nonrandomised Studies in Meta-analyses. Ottawa Health Research Institute Web site 2014;7.
13.
Kamarajah SK, Phillips AW, Griffiths EA, Ferri L, Hofstetter WL, Markar SR. Esophagectomy or Total Gastrectomy for Siewert 2 Gastroesophageal Junction (GEJ) Adenocarcinoma? A Registry-Based Analysis. Ann Surg Oncol. 2021;28(13):8485-94.PubMedPubMedCentral
14.
Zheng B, Chen YB, Hu Y, Wang JY, Zhou ZW, Fu JH. Comparison of transthoracic and transabdominal surgical approaches for the treatment of adenocarcinoma of the cardia. Chin J Cancer 2010;29(8):747-51.PubMed
15.
Xing J, Liu M, Xu K, Gao P, Tan F, Yao Z, et al. 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;12:11813-21.PubMedPubMedCentral
16.
Voron T, Gronnier C, Pasquer A, Thereaux J, Gagniere J, Lebreton G, et al. Adenocarcinoma of the oesophagogastric junction Siewert II: An oesophageal cancer better cured with total gastrectomy. Eur J Surg Oncol 2019;45(12):2473-81.PubMed
17.
Tosolini C, Reim D, Schirren R, Feith M, Friess H, Novotny AR. 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 2019;45(3):416-24.PubMed
18.
Reddavid R, Strignano P, Sofia S, Evangelista A, Deiro G, Cannata G, et al. Transhiatal distal esophagectomy for Siewert type II cardia cancer can be a treatment option in selected patients. Eur J Surg Oncol 2019;45(10):1943-9.PubMed
19.
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.PubMed
20.
Chen Y, Zhao XK, Xu RH, Song X, Yang MM, Zhou FY, et al. 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.PubMedPubMedCentral
21.
Blank S, Schmidt T, Heger P, Strowitzki MJ, Sisic L, Heger U, et al. Surgical strategies in true adenocarcinoma of the esophagogastric junction (AEG II): thoracoabdominal or abdominal approach? Gastric Cancer 2018;21(2):303-14.PubMed
22.
De Pasqual CA, van der Sluis PC, Weindelmayer J, Lagarde SM, Giacopuzzi S, De Manzoni G, et al. Transthoracic esophagectomy compared to transhiatal extended gastrectomy for adenocarcinoma of the esophagogastric junction: a multicenter retrospective cohort study. Dis Esophagus 2022;35(8).
23.
Rüdiger Siewert J, Feith M, Werner M, Stein HJ. Adenocarcinoma of the esophagogastric junction: results of surgical therapy based on anatomical/topographic classification in 1,002 consecutive patients. Ann Surg 2000;232(3):353-61.PubMedPubMedCentral
24.
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.PubMedPubMedCentral
25.
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.PubMed
26.
Kurokawa Y, Sasako M, Sano T, Yoshikawa T, Iwasaki Y, Nashimoto A, et al. 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.PubMedPubMedCentral
27.
Mertens AC, Kalff MC, Eshuis WJ, Van Gulik TM, Van Berge Henegouwen MI, Gisbertz SS, et al. Transthoracic Versus Transhiatal Esophagectomy for Esophageal Cancer: A Nationwide Propensity Score-Matched Cohort Analysis. Ann Surg Oncol 2021;28(1):175-83.PubMed
28.
Nakamura T, Ide H, Eguchi R, Ota M, Shimizu S, Isono K. Adenocarcinoma of the esophagogastric junction: a summary of responses to a questionnaire on adenocarcinoma of the esophagus and the esophagogastric junction in Japan. Dis Esophagus 2002;15(3):219-25.PubMed
29.
Omloo JM, Lagarde SM, Hulscher JB, Reitsma JB, Fockens P, van Dekken H, et al. 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; discussion -1.PubMed
30.
Ovrebo KK, Lie SA, Laerum OD, Svanes K, Viste A. Long-term survival from adenocarcinoma of the esophagus after transthoracic and transhiatal esophagectomy. World J Surg Oncol 2012;10:130.PubMedPubMedCentral
31.
32.
van der Werf LR, Wijnhoven BPL, Fransen LFC, van Sandick JW, Nieuwenhuijzen GAP, Busweiler LAD, et al. A National Cohort Study Evaluating the Association Between Short-term Outcomes and Long-term Survival After Esophageal and Gastric Cancer Surgery. Ann Surg 2019;270(5):868-76.PubMed
33.
Zhou J, Wang H, Niu Z, Chen D, Wang D, Lv L, et al. 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.PubMed
34.
Holguin RAP, Wong WG, Shen C, Go PH, Reed MF, Taylor MD. Esophagectomy vs Gastrectomy for Early Stage Adenocarcinoma of the Gastroesophageal Junction: What is the Optimal Oncologic Surgical Treatment? Semin Thorac Cardiovasc Surg 2022.
35.
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.PubMed
36.
Johansson J, Djerf P, Oberg S, Zilling T, von Holstein CS, Johnsson F, et al. Two different surgical approaches in the treatment of adenocarcinoma at the gastroesophageal junction. World J Surg 2008;32(6):1013-20.PubMed
37.
Kneuertz PJ, Hofstetter WL, Chiang YJ, Das P, Blum M, Elimova E, et al. Long-Term Survival in Patients with Gastroesophageal Junction Cancer Treated with Preoperative Therapy: Do Thoracic and Abdominal Approaches Differ? Ann Surg Oncol 2016;23(2):626-32.PubMed
38.
Martin JT, Mahan A, Zwischenberger JB, McGrath PC, Tzeng CW. 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.PubMed
39.
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.PubMed
40.
Haverkamp L, Ruurda JP, van Leeuwen MS, Siersema PD, van Hillegersberg R. Systematic review of the surgical strategies of adenocarcinomas of the gastroesophageal junction. Surg Oncol 2014;23(4):222-8.PubMed
41.
Heger P, Blank S, Gooßen K, Nienhüser H, Diener MK, Ulrich A, et al. Thoracoabdominal versus transhiatal surgical approaches for adenocarcinoma of the esophagogastric junction-a systematic review and meta-analysis. Langenbeck's Arch Surg 2019;404(1):103-13.
42.
Wei M-T, Zhang Y-C, Deng X-B, Yang T-H, He Y-Z, Wang Z-Q. Transthoracic vs transhiatal surgery for cancer of the esophagogastric junction: a meta-analysis. World J Gastroenterol 2014;20(29):10183-92.PubMedPubMedCentral
43.
Wu H, Shang L, Du F, Fu M, Liu J, Fang Z, et al. Transhiatal versus transthoracic surgical approach for Siewert type II adenocarcinoma of the esophagogastric junction: a meta-analysis. Expert Rev Gastroenterol Hepatol 2020;14(11):1107-17.PubMed
44.
Yang K, Chen HN, Chen XZ, Lu QC, Pan L, Liu J, et al. Transthoracic resection versus non-transthoracic resection for gastroesophageal junction cancer: a meta-analysis. PLoS One 2012;7(6):e37698.PubMedPubMedCentral
45.
Zheng Z, Cai J, Yin J, Zhang J, Zhang ZT, Wang KL. Transthoracic versus abdominal-transhiatal resection for treating Siewert type II/III adenocarcinoma of the esophagogastric junction: a meta-analysis. Int J Clin Exp Med 2015;8(10):17167-82.PubMedPubMedCentral
46.
Leers JM, Knepper L, van der Veen A, Schröder W, Fuchs H, Schiller P, et al. The CARDIA-trial protocol: a multinational, prospective, randomized, clinical trial comparing transthoracic esophagectomy with transhiatal extended gastrectomy in adenocarcinoma of the gastroesophageal junction (GEJ) type II. BMC Cancer 2020;20(1):781.PubMedPubMedCentral
47.
Song Q, Li X, Wu D, Li S, Xie T, Lu Y, et al. The abdominal-transhiatal surgical approach versus the thoracoabdominal surgical approach in Siewert type II adenocarcinoma of the esophagogastric junction: protocol for a multicenter prospective, open, parallel, and randomized controlled trial. BMC Cancer 2022;22(1):318.PubMedPubMedCentral
48.
Derogar M, Lagergren P. Health-related quality of life among 5-year survivors of esophageal cancer surgery: a prospective population-based study. J Clin Oncol 2012;30(4):413-8.PubMed
49.
Haverkamp L, Seesing MF, Ruurda JP, Boone J, R VH. Worldwide trends in surgical techniques in the treatment of esophageal and gastroesophageal junction cancer. Dis Esophagus 2017;30(1):1-7.PubMed
50.
51.
Hermanek P, Wittekind C. The pathologist and the residual tumor (R) classification. Pathol Res Pract 1994;190(2):115-23.PubMed
52.
Fuchs H, Hölscher AH, Leers J, Bludau M, Brinkmann S, Schröder W, 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.PubMed
53.
Di Leo A, Zanoni A. Siewert III adenocarcinoma: treatment update. Updat Surg 2017;69(3):319-25.
54.
Sobin LH, Gospodarowicz MK, Wittekind C. TNM classification of malignant tumours: John Wiley & Sons; 2011.
55.
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;34:18-31.PubMed
Metadata
Title
Oesophagectomy or Total Gastrectomy for the Management of Siewert II Gastroesophageal Junction Cancer: a Systematic Review and Meta-analysis
Authors
James Walmsley
Arun Ariyarathenam
Richard Berrisford
Lee Humphreys
Grant Sanders
Ji Chung Tham
Tim Wheatley
David S.Y. Chan
Publication date
03-04-2023
Publisher
Springer US
Published in
Journal of Gastrointestinal Surgery / Issue 7/2023
Print ISSN: 1091-255X
Electronic ISSN: 1873-4626
DOI
https://doi.org/10.1007/s11605-023-05661-5

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