Siewert II esophagogastric junction adenocarcinoma: Still searching for the right treatment transabdominal or transthoracic surgical approaches?

Author:

Maatouk Mohamed1ORCID,Nouira Mariem2,Dhaou Anis Ben1,Kbir Ghassen Hamdi1,Mabrouk Aymen1,Khlifa Mohamed Ben3,Daldoul Sami1,Sayari Sofien1,Moussa Mounir Ben1

Affiliation:

1. A21 Surgery Department, Charles Nicolle Hospital, Faculty of Medicine of Tunis, Tunis El Manar University, Tunis, Tunisia

2. Service of Medical Epidemiology, Charles Nicolle Hospital, Faculty of medicine of Tunis, Tunis El Manar University, Tunis, Tunisia

3. Department of Surgery, Tahar Sfar Hospital, Mahdia, Tunisia

Abstract

Introduction To date, the discussion is still ongoing whether the Siewert II adenocarcinoma of the esophagogastric junction (AEG) should be resected either by thoracoabdominal esophagectomy or gastrectomy with resection of the distal esophagus by transhiatal extension. The aim of our study was to compare the oncological and perioperative outcomes of the transthoracic approach (TTA) and the transabdominal approach (TAA). Methods Searches of electronic databases identifying studies from Cochrane, PubMed and Google Scholar were performed. Randomised and non-randomised studies comparing TTA and TAA approaches for surgical treatment of AEG Siewert type II were included. The Newcastle–Ottawa and Jada scales were used to evaluate methodological quality. The risk of bias was assessed using the Rob v2 and Robins-I tools. Meta-analyses were conducted for the outcomes. Results We included 17 trials (2 randomised controlled trials and 15 cohorts) involving 15297 patients. Longer three-year overall survival, five-year overall survival and R0 resection rates were observed in the TTA group. However, TTA had greater morbidity and pulmonary complications. Conclusion Transthoracic approach appears to be preferable for selected Siewert II tumours. This may lead to higher survival rates and better R0 resection rate. Well-designed studies are needed to confirm the results of this systematic review.

Publisher

SAGE Publications

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