Surgical Treatment of Gastroesophageal Junction Cancer

Although the incidence of gastroesophageal junction (GEJ) adenocarcinoma has been increasing worldwide, no standardized surgical strategy for its treatment has been established. This study aimed to provide an update on the surgical treatment of GEJ adenocarcinoma by reviewing previous reports and propose recommended surgical approaches. The Siewert classification is widely used for determining which surgical procedure is used, because previous studies have shown that the pattern of lymph node (LN) metastasis depends on tumor location. In terms of surgical approaches for GEJ adenocarcinoma, a consensus was reached based on two randomized controlled trials. Siewert types I and III are treated as esophageal cancer and gastric cancer, respectively. Although no consensus has been reached regarding the treatment of Siewert type II, several retrospective studies suggested that the optimal treatment strategy includes paraaortic LN dissection. Against this background, a Japanese nationwide prospective trial is being conducted to determine the proportion of LN metastasis in GEJ cancers and to identify the optimal extent of LN dissection in each type.

Minimally invasive esophageal surgery-standard of care-our experience.

Background: Surgery is the most effective treatment for the resectable esophageal cancer of the middle & lower third and gastro-esophageal junction (GEJ) tumors. We hereby scrutinise our experience in minimally invasive esophageal surgery (MIES) to evaluate its safety and efficacy as an oncosurgical procedure. Methods: The study included99consecutive patients. Depending on the location of the tumor, either thoracoscopic transthoracic esophagectomy (TTE) in prone position or laparoscopic transhiatal esophagectomy (THE) was planned. 2 field comprehensive nodal dissection were part of both the surgical procedures. Results: 05 patients were excluded, 18 were inoperable and 12 had open surgery. 64 underwent MIES (THE-37, TTE-27), Male: Female-31:33. Nodal Harvest (nodes): THE-14.27, TTE-14.77. Margins (cm): THE-proximal (P) - 6.70, distal (D) -2.51, TTE: (P)-5.41, (D)-5.11. 30 days Morbidity (26): cervical leak-05, left vocal cord palsy-05, tracheostomy-03, respiratory insufficiency-03, aspiration-01, chyle leak-01, exploratory laparotomy-01, cardiac-02, stroke-01, surgical emphysema -01, abdominal wound Infection -03 30 days Mortality (1) –pulmonary embolus. Operative time (minutes): THE-234, TTE-322. Blood loss (ml/patient): THE-265, TTE-380. Hospital stays (days): THE-7.3, TTE-10. Conclusions: 79% of properly selected & evaluated cases underwent MIES, with one Mortality and 26 events of morbidity. 6% required conversion. The procedure detected inoperability in 16% cases. The nodal yield, status of margins, operative time, blood loss and hospital stay indicates that MIES has a future to become a standard of care in the treatment of esophageal cancers.