Thoracoabdominal gastrectomy and distal 2/3 esophageal resection with wide lymph node dissection for type II and III adenocarcinoma at the gastro-esophageal junction.

Abstract:

BACKGROUND:For locally advanced Siewert type II and III tumors we have performed total gastrectomy including resection of the distal 2/3 of the esophagus, through separate abdominal and right chest incisions (THX-ABD). The procedure involves wide lymphadenectomy in the abdomen/chest and a Roux-en-Y jejunostomy to the level of the azygos vein or above. The aim of the study was to investigate short- and long-term results for this rarely used procedure. METHODS:Retrospective study of 83 radio-chemotherapy naïve patients with adenocarcinoma at the gastro-esophageal junction (Siewert type II n = 65 and type III n = 18) operated upon 1986-2011. RESULTS:2/83 (2.4%) patients died in hospital. 70/83 (84%) patients had R0-resections. 82/83 (99%) patients had free longitudinal resection margins. Overall 5-year survival was 22/83 (27%). CONCLUSION:THX-ABD can be performed with high rates of R0 resections and with low in-hospital mortality. Long-term survival rate was not better compared with less extensive surgical procedures.

journal_name

Am J Surg

authors

Jeremiasen M,Walther B,Djerf P,Staël von Holstein C,Zilling T,Hermansson M,Falkenback D,Johansson J

doi

10.1016/j.amjsurg.2018.11.049

subject

Has Abstract

pub_date

2019-08-01 00:00:00

pages

329-334

issue

2

eissn

0002-9610

issn

1879-1883

pii

S0002-9610(18)30878-X

journal_volume

218

pub_type

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