Thoracoabdominal versus transhiatal surgical approaches for adenocarcinoma of the esophagogastric junction—a systematic review and meta-analysis

  • Patrick Heger
  • Susanne Blank
  • Käthe Gooßen
  • Henrik Nienhüser
  • Markus K. Diener
  • Alexis Ulrich
  • André L. Mihaljevic
  • Thomas SchmidtEmail author
Systematic Reviews and Meta-analyses



The aim of this systematic review and meta-analysis was to compare the oncological and perioperative outcomes of transhiatally extended gastrectomy (TEG) and thoracoabdominal esophagectomy (TAE) for therapy of adenocarcinomas of the esophagogastric junction (AEG) with focus on AEG type II, as the optimal approach for these tumors is still unclear.


MEDLINE, EMBASE, and the Cochrane Library (CENTRAL) were searched until July 24, 2018. Studies comparing TAE and TEG for surgical treatment of AEG type tumors have been included. Patient’s baseline and perioperative data have been extracted and meta-analyses have been conducted for the outcomes: number of dissected lymph nodes, R0-resection rate, anastomotic leak rate, postoperative morbidity, and 30-day mortality.


Of 6709 articles identified, 8 studies have been included for further analysis. One thousand thirty-four patients underwent TAE, and 1177 patients TEG. No differences were found between the approaches in regard to number of dissected lymph nodes (MD − 0.96; 95% CI − 3.07 to 1.15; p = 0.37), R0-resection rates (OR 0.97; 95% CI 0.57 to 1.63; p = 0.90), anastomotic leak rates (OR 1.13; 95% CI 0.69 to 1.86; p = 0.63), and 30-day mortality (OR 1.53; 95% CI 0.90 to 2.61; p = 0.11). However, a higher rate of postoperative morbidity was found after TAE (OR 1.55; 95% CI 1.12 to 2.14; p = 0.008).


The optimal approach to surgical therapy of AEG II still remains unclear. This study identified a significantly higher rate of postoperative morbidity after TAE at comparable surgical outcomes. Due to major limitations concerning the quality of included studies, current data strongly mandates a properly designed randomized controlled trial to identify the optimal surgical approach for AEG type II tumors.


Esophageal adenocarcinoma Esophagogastric junction cancer Esophageal and gastric surgery Gastrectomy Esophagectomy 


Author contributions

PH, SB, HN, ALM, and TS are responsible for conception and design of the study. PH, SB, KG, ALM, and TS performed the acquisition and analysis of the data, and drafted the manuscript. HN, MKD, and AU offered substantial contributions to interpretation of the data and critically revised the manuscript. All authors gave their final approval of this version of the manuscript and are accountable for all aspects of the work.

Compliance with ethical standards

No funding source is available for this study. However, the resources and facilities of the University of Heidelberg were used in conducting this study.

The authors declare no conflict of interest.

This article does not contain any studies with human participants or animals performed by any of the authors.

Supplementary material

423_2018_1745_MOESM1_ESM.docx (16 kb)
Supplement 1 : Exemplary search strategy for MEDLINE via Pubmed. (DOCX 16 kb)
423_2018_1745_MOESM2_ESM.docx (60 kb)
Supplement 2 : Data extraction sheet. (DOCX 59 kb)
423_2018_1745_MOESM3_ESM.xlsx (15 kb)
Supplement 3 : Risk of bias for included non-randomized studies evaluated by using ROBINS-I assessment tool [23]. (XLSX 14 kb)


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Copyright information

© Springer-Verlag GmbH Germany, part of Springer Nature 2019

Authors and Affiliations

  • Patrick Heger
    • 1
    • 2
  • Susanne Blank
    • 1
  • Käthe Gooßen
    • 2
  • Henrik Nienhüser
    • 1
  • Markus K. Diener
    • 1
    • 2
  • Alexis Ulrich
    • 1
  • André L. Mihaljevic
    • 1
    • 2
  • Thomas Schmidt
    • 1
    Email author return OK on get
  1. 1.Department of General, Visceral and Transplantation SurgeryUniversity of HeidelbergHeidelbergGermany
  2. 2.The Study Centre of the German Surgical Society (SDGC)University of HeidelbergHeidelbergGermany

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