Curative resection for adenocarcinoma of the gastro-esophageal junction following neo-adjuvant chemotherapy—thoraco-abdominal vs. trans-abdominal approach

Kumar, Naveena AN (2020) Curative resection for adenocarcinoma of the gastro-esophageal junction following neo-adjuvant chemotherapy—thoraco-abdominal vs. trans-abdominal approach. Langenbeck's Archives of Surgery, 406 (3). pp. 613-621. ISSN 1435-2443

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Abstract

Purpose: This study compares the short- and long-term outcomes between the left thoraco-abdominal and trans-abdominal approaches for radical resection of adenocarcinoma of the gastro-esophageal junction (GEJ) (Siewert types II and III) following neo-adjuvant chemotherapy. Methods: A retrospective analysis of a prospectively maintained database of patients from May 2008 to December 2016. Demographic variables, perioperative outcomes, and survival were compared between two approaches. Results: Of the 792 patients, who underwent total/proximal gastrectomy during the specified time interval, 162 had Siewert’s type II/III lesions, of which 147 received neoadjuvant chemotherapy and were included in the study. Ninety-two and 55 patients underwent definitive surgery through trans-abdominal and left thoraco-abdominal approach respectively. On baseline endoscopy, 81.8% of patients in the left thoraco-abdominal group had lower esophageal mucosal infiltration as compared to 41.3% in the trans-abdominal group (p < 0.001). Both groups were comparable in terms of duration of surgery, blood loss, complications, severity of complications (Clavien-Dindo grade), duration of hospital stay, R0 resection rate, length of proximal margin, and lymph node yield. At a median follow-up of 24 months, there was no difference in recurrence rate and survival between the groups. Conclusion: Both left thoraco-abdominal and trans-abdominal are comparable surgical approaches for tumors involving the GEJ in terms of morbidity, perioperative, and long-term oncological outcomes. In patients with lower esophageal involvement, the left thoraco-abdominal approach is a feasible alternative with no added overall morbidity or mortality and can be preferred especially in cases, where a safe proximal margin and anastomosis is deemed technically challenging.

Item Type: Article
Uncontrolled Keywords: Gastro-esophageal Junction (GEJ) ; Adenocarcinoma ; Left Thoraco-abdominal ; Trans-abdominal ; Approach.
Subjects: Medicine > KMC Manipal > Surgical Oncology
Depositing User: KMC Library
Date Deposited: 09 Jun 2021 04:25
Last Modified: 09 Jun 2021 04:25
URI: http://eprints.manipal.edu/id/eprint/156801

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