World Journal of Surgery

, 35:2245 | Cite as

Long-term Outcomes of Extended Proximal Gastrectomy for Oesophagogastric Junctional Tumours

  • Omar Khan
  • Steven Goh
  • Ben Byrne
  • Shaw Somers
  • Stuart Mercer
  • Simon Toh
Article

Abstract

Background

There is no consensus on the optimum approach for resection of oesophagogastric junctional (OGJ) tumours. We prospectively evaluated the efficacy of transabdominal radical extended proximal gastrectomy with oesophagogastric anastomosis (EPGOG) for selected tumours of the OGJ.

Methods

Between 1998 and 2007, 66 selected consecutive patients with tumours of the OGJ underwent successful EPGOG. Selection was limited to tumours where the maximal proximal extent was 36 cm ab oral. Pre-, peri-, and postoperative outcomes together with long-term survival data for these patients were prospectively collected.

Results

Median theatre time was 242 min (range = 120–480), with a median blood loss of 300 ml (range = 50–1720). Eighty-nine percent of patients were extubated in theatre; major complications occurred in 9 (14%) patients, with an overall in-hospital mortality rate of 8%. Thirty-five (53%) patients had nodal disease and the median lymph node yield was 13 (range = 4–36), with an R0 resection rate of 80%. In terms of long-term outcomes, the 2- and 5-year actuarial survival rates were 54 ± 6% and 41 ± 6%.

Conclusion

Extended radical proximal gastrectomy with oesophagogastric anastomosis for selected junctional tumours is a feasible technique which does not compromise oncological principles as evidenced by an excellent long-term survival rate.

References

  1. 1.
    Muller JM, Ersami H, Stelzner M et al (1990) Surgical therapy of oesophageal cancer. Br J Surg 77:845–857PubMedCrossRefGoogle Scholar
  2. 2.
    Ferguson MK, Durkin AE (2002) Preoperative prediction of the risk of pulmonary complications after esophagectomy for cancer. J Thorac Cardiovasc Surg 123:661–669PubMedCrossRefGoogle Scholar
  3. 3.
    Alexiou C, Khan OA, Black E, Field ML, Onyeaka CVP, Beggs L, Duffy JP, Beggs FD (2006) Survival after esophageal resection for carcinoma: the importance of the histological cell type. Ann Thorac Surg 82:1073–1077PubMedCrossRefGoogle Scholar
  4. 4.
    Altorki M, Skinner D (2001) Should en bloc esophagectomy be the standard of care for esophageal carcinoma? Ann Surg 234:581–587PubMedCrossRefGoogle Scholar
  5. 5.
    Yannopoulos P, Theodoridis P, Manes K (2009) Esophagectomy without thoracotomy: 25 years of experience over 750 patients. Langenbecks Arch Surg 394:611–616PubMedCrossRefGoogle Scholar
  6. 6.
    Wayman J, Dresner SM, Raimes SA, Griffin SM (1999) Transhiatal approach to total gastrectomy for adenocarcinoma of the gastric cardia. Br J Surg 86:536–540PubMedCrossRefGoogle Scholar
  7. 7.
    Costi R, Himpens J, Bruyns J, Cadière GB (2004) Totally laparoscopic transhiatal esophago-gastrectomy without thoracic or cervical access. The least invasive surgery for adenocarcinoma of the cardia? Surg Endosc 18:629–632PubMedCrossRefGoogle Scholar
  8. 8.
    Medical Research Council Oesophageal Cancer Working Party (2002) Surgical resection with or without preoperative chemotherapy in oesophageal cancer: a randomised controlled trial. Lancet 359:1727–1733CrossRefGoogle Scholar
  9. 9.
    Alderson D, Courtney SP, Kennedy RH (1994) Radical transhiatal oesophagectomy under direct vision. Br J Surg 81:404–407PubMedCrossRefGoogle Scholar
  10. 10.
    Sobin LH, Wittekind CH (eds) (2002) UICC TNM classification of malignant tumours, 6th edn. Wiley, HobokenGoogle Scholar
  11. 11.
    Siewert JR, Stein HJ (1998) Classification of adenocarcinoma of the oesophagogastric junction. Br J Surg 85:1457–1459PubMedCrossRefGoogle Scholar
  12. 12.
    Wijnhoven BP, Siersema PD, Hop WC, van Dekken H, Tilanus HW (1999) Adenocarcinomas of the distal oesophagus and gastric cardia are one clinical entity—Rotterdam Oesophageal Tumour Study Group. Br J Surg 86:529–535PubMedCrossRefGoogle Scholar
  13. 13.
    Ellis FH Jr, Heatley GJ, Balogh K (1997) Proposal for improved staging criteria for carcinoma of the esophagus and cardia. Eur J Cardiothorac Surg 12:361–364PubMedCrossRefGoogle Scholar
  14. 14.
    van de Ven C, De Leyn P, Coosemans W, Van Raemdonck D, Lerut T (1999) Three-field lymphadenectomy and pattern of lymph node spread in T3 adenocarcinoma of the distal esophagus and the gastro-esophageal junction. Eur J Cardiothorac Surg 15:769–773PubMedCrossRefGoogle Scholar
  15. 15.
    Blot WJ, Devesa SS, Kneller RW, Fraumeni JF (1991) Rising incidence of adenocarcinoma of the oesophagus and gastric cardia. JAMA 265:1287–1289PubMedCrossRefGoogle Scholar
  16. 16.
    Hulscher JB, Tijssen JG, Obertop H, van Lanschot JB (2001) Transthoracic versus transhiatal resection for carcinoma of the esophagus: a meta-analysis. Ann Thorac Surg 72:306–313PubMedCrossRefGoogle Scholar
  17. 17.
    Hulscher JB, van Sandick JW, de Boer AG et al (2002) Extended transthoracic resection compared with limited transhiatal resection for adenocarcinoma of the esophagus. N Engl J Med 347:1662–1669PubMedCrossRefGoogle Scholar
  18. 18.
    Davies AR, Forshaw MJ, Khan AA, Noorani AS, Patel VM, Strauss DC, Mason RC (2008) Transhiatal esophagectomy in a high volume institution. World J Surg Oncol 6:88PubMedCrossRefGoogle Scholar
  19. 19.
    Park DP, Welch CA, Harrison DA et al (2009) Outcomes following oesophagectomy in patients with oesophageal cancer: a secondary analysis of the INARC Case Mix Programme Database. Crit Care 13(S2):S1PubMedCrossRefGoogle Scholar
  20. 20.
    Khan OA, Cruttenden-Wood D, Toh SK (2010) Is an involved circumferential resection margin following oesphagectomy for cancer an important prognostic indicator? Interact Cardiovasc Thorac Surg 11:645–648PubMedCrossRefGoogle Scholar
  21. 21.
    Allum WH, Stenning SP, Bancewicz J, Clark PI, Langley RE (2009) Long-term results of a randomized trial of surgery with or without preoperative chemotherapy in esophageal cancer. J Clin Oncol 27:5062–5067PubMedCrossRefGoogle Scholar
  22. 22.
    Rizk NP, Ishwaran H, Rice TW et al (2010) Optimum lymphadenectomy for esophageal cancer. Ann Surg 251:46–50PubMedCrossRefGoogle Scholar
  23. 23.
    Khan OA, Fitzgerald JJ, Soomro I, Beggs FD, Morgan WE, Duffy JP (2003) Prognostic significance of circumferential resection margin involvement following oesophagectomy for cancer. Br J Cancer 88:1549–1552PubMedCrossRefGoogle Scholar

Copyright information

© Société Internationale de Chirurgie 2011

Authors and Affiliations

  • Omar Khan
    • 1
  • Steven Goh
    • 1
  • Ben Byrne
    • 1
  • Shaw Somers
    • 1
  • Stuart Mercer
    • 1
  • Simon Toh
    • 1
  1. 1.Department of Upper GI SurgeryQueen Alexandra HospitalPortsmouthUK

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