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. 2022 Apr 27;14(4):304-314.
doi: 10.4240/wjgs.v14.i4.304.

Laparoscopic-assisted vs open transhiatal gastrectomy for Siewert type II adenocarcinoma of the esophagogastric junction: A retrospective cohort study

Qi-Ying Song  1 , Xiong-Guang Li  2 , Li-Yu Zhang  1 , Di Wu  1 , Shuo Li  1 , Ben-Long Zhang  1 , Zi-Yao Xu  1 , Ri-Li-Ge Wu  3 , Xin Guo  4 , Xin-Xin Wang  5
Affiliations

Laparoscopic-assisted vs open transhiatal gastrectomy for Siewert type II adenocarcinoma of the esophagogastric junction: A retrospective cohort study

Qi-Ying Song et al. World J Gastrointest Surg. .

Abstract

Background: The studies of laparoscopic-assisted transhiatal gastrectomy (LTG) in patients with Siewert type II adenocarcinoma of the esophagogastric junction (AEG) are scarce.

Aim: To compare the surgical efficiency of LTG with the open transhiatal gastrectomy (OTG) for patients with Siewert type II AEG.

Methods: We retrospectively evaluated a total of 578 patients with Siewert type II AEG who have undergone LTG or OTG at the First Medical Center of the Chinese People's Liberation Army General Hospital from January 2014 to December 2019. The short-term and long-term outcomes were compared between the LTG (n = 382) and OTG (n = 196) groups.

Results: Compared with the OTG group, the LTG group had a longer operative time but less blood loss, shorter length of abdominal incision and an increased number of harvested lymph nodes (P < 0.05). Patients in the LTG group were able to eat liquid food, ambulate, expel flatus and discharge sooner than the OTG group (P < 0.05). No significant differences were found in postoperative complications and R0 resection. The 3-year overall survival and disease-free survival performed better in the LTG group compared with that in the OTG group (88.2% vs 79.2%, P = 0.011; 79.7% vs 73.0%, P = 0.002, respectively). In the stratified analysis, both overall survival and disease-free survival were better in the LTG group than those in the OTG group for stage II/III patients (P < 0.05) but not for stage I patients.

Conclusion: For patients with Siewert type II AEG, LTG is associated with better short-term outcomes and similar oncology safety. In addition, patients with advanced stage AEG may benefit more from LTG in the long-term outcomes.

Keywords: Adenocarcinoma of the esophagogastric junction; Laparoscopic-assisted transhiatal gastrectomy; Open transhiatal gastrectomy; Siewert type II.

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Conflict of interest statement

Conflict-of-interest statement: All authors declare that there is no conflict of interest.

Figures

Figure 1
Figure 1
Flow chart of patient selection. AEG: Adenocarcinoma of the esophagogastric junction.
Figure 2
Figure 2
Comparison of overall survival rates between the laparoscopic-assisted transhiatal gastrectomy and open transhiatal gastrectomy groups. A. Comparison of overall survival rates between the laparoscopic-assisted transhiatal gastrectomy (LTG) and open transhiatal gastrectomy (OTG) groups for all patients; B: Comparison of overall survival rates between the LTG and OTG groups for stage I patients; C: Comparison of overall survival rates between the LTG and OTG groups for stage II patients; D: Comparison of overall survival rates between the LTG and OTG groups for stage III patients. CI: Confidence interval; HR: Hazard ratio.
Figure 3
Figure 3
Comparison of disease-free survival rates between the laparoscopic-assisted transhiatal gastrectomy and open transhiatal gastrectomy groups. A: Comparison of disease-free survival rates between the laparoscopic-assisted transhiatal gastrectomy (LTG) and open transhiatal gastrectomy (OTG) groups for all patients; B: Comparison of disease-free survival rates between the LTG and OTG groups for stage I patients; C: Comparison of disease-free survival rates between the LTG and OTG groups for stage II patients; D: Comparison of disease-free survival rates between the LTG and OTG groups for stage III patients. CI: Confidence interval; HR: Hazard ratio.
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