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

Jeremiasen, Martin LU ; Walther, Bruno LU ; Djerf, Pauline LU ; Staël von Holstein, Christer LU ; Zilling, Thomas LU ; Hermansson, Michael LU ; Falkenback, Dan LU and Johansson, Jan LU (2018) In American Journal of Surgery
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... (More)

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.

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author
organization
publishing date
type
Contribution to journal
publication status
epub
subject
keywords
Adenocarcinoma, Gastrectomy, Gastro-esophageal junction, Lymph nodes, Thoracoabdominal
in
American Journal of Surgery
publisher
Elsevier
external identifiers
  • scopus:85059563320
ISSN
0002-9610
DOI
10.1016/j.amjsurg.2018.11.049
language
English
LU publication?
yes
id
1ad38ed9-3e67-41f1-98d0-39aaba076bda
date added to LUP
2019-01-18 14:31:22
date last changed
2019-02-20 11:43:35
@article{1ad38ed9-3e67-41f1-98d0-39aaba076bda,
  abstract     = {<p>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.</p>},
  author       = {Jeremiasen, Martin and Walther, Bruno and Djerf, Pauline and Staël von Holstein, Christer and Zilling, Thomas and Hermansson, Michael and Falkenback, Dan and Johansson, Jan},
  issn         = {0002-9610},
  keyword      = {Adenocarcinoma,Gastrectomy,Gastro-esophageal junction,Lymph nodes,Thoracoabdominal},
  language     = {eng},
  month        = {12},
  publisher    = {Elsevier},
  series       = {American Journal of Surgery},
  title        = {Thoracoabdominal gastrectomy and distal 2/3 esophageal resection with wide lymph node dissection for type II and III adenocarcinoma at the gastro-esophageal junction},
  url          = {http://dx.doi.org/10.1016/j.amjsurg.2018.11.049},
  year         = {2018},
}