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Long-term oncological outcomes of laparoscopic versus open transhiatal resection for patients with Siewert type II adenocarcinoma of the esophagogastric junction

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Abstract

Background

Insufficient information is available about the long-term outcomes of patients with Siewert type II adenocarcinoma of the esophagogastric junction (AEG) who undergo laparoscopic transhiatal approach (LTH). Here we evaluated the oncological safety of LTH for patients with Siewert type II AEG compared with the open transhiatal approach (OTH).

Methods

Subjects included 79 patients with Siewert type II AEG who underwent gastrectomy combined with lower esophagectomy from 2008 to 2018 at our institution. Overall survival (OS), recurrence-free survival (RFS), status of adjuvant chemotherapy, late-phase complications, and recurrence patterns were compared between the OTH (n = 29) and LTH groups (n = 43).

Results

The median observation periods were 60 months (6–120 months) and 36 months (1–88) for the OTH and LTH groups, respectively. The 5-year OS rates were significantly different: 74% (95% CI 71–77%) and 98% (95% CI 97–99) in the OTH and LTH groups (HR 0.10, 95% CI 0.01–0.83), respectively, though the OTH group included more patients with advanced disease. After stratification, according to pathological stage to adjust for selection bias, the 5-year OS and RFS rates were longer, but not significantly different among patients in the LTH group with pStage III (HR 0.42, 95% CI 0.05–3.47; HR 0.47, 95% CI 0.10–2.12, respectively). Recurrence patterns were similar in the both groups.

Conclusions

Long-term outcomes of the LTH group were not inferior to those of the OTH group, suggesting the possibility of LTH as a treatment option for selected patients with Siewert type II AEG.

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References

  1. Kusano C, Gotoda T, Khor CJ, Katai H, Kato H, Taniguchi H, Shimoda T (2008) Changing trends in the proportion of adenocarcinoma of the esophagogastric junction in a large tertiary referral center in Japan. J Gastroenterol Hepatol 23:1662–1665. https://doi.org/10.1111/j.1440-1746.2008.05572.x

    Article  PubMed  Google Scholar 

  2. Yamashita H, Seto Y, Sano T, Makuuchi H, Ando N, Sasako M, Association OBOTJGC (2016) Results of a nation-wide retrospective study of lymphadenectomy for esophagogastric junction carcinoma. Gastric Cancer 20:1–15. https://doi.org/10.1007/s10120-016-0663-8

    Article  CAS  Google Scholar 

  3. Buas MF, Vaughan TL (2013) Epidemiology and risk factors for gastroesophageal junction tumors: understanding the rising incidence of this disease. Semin Radiat Oncol 23:3–9. https://doi.org/10.1016/j.semradonc.2012.09.008

    Article  PubMed  PubMed Central  Google Scholar 

  4. Lagergren J, Lagergren P (2013) Recent developments in esophageal adenocarcinoma. CA Cancer J Clin 63:232–248. https://doi.org/10.1002/caac.21185

    Article  PubMed  Google Scholar 

  5. Edgren G, Adami HO, Vainio EW, Nyrén O (2013) A global assessment of the oesophageal adenocarcinoma epidemic. Gut 62:1406–1414. https://doi.org/10.1136/gutjnl-2012-302412

    Article  PubMed  Google Scholar 

  6. Sasako M, Sano T, Yamamoto S, Sairenji M, Arai K, Kinoshita T, Nashimoto A, Hiratsuka M (2006) Left thoracoabdominal approach versus abdominal-transhiatal approach for gastric cancer of the cardia or subcardia: a randomised controlled trial. Lancet Oncol 7:644–651. https://doi.org/10.1016/S1470-2045(06)70766-5

    Article  PubMed  Google Scholar 

  7. Kurokawa Y, Sasako M, Sano T, Yoshikawa T, Iwasaki Y, Nashimoto A, Ito S, Kurita A, Mizusawa J, Nakamura K (2015) Ten-year follow-up results of a randomized clinical trial comparing left thoracoabdominal and abdominal transhiatal approaches to total gastrectomy for adenocarcinoma of the oesophagogastric junction or gastric cardia. Br J Surg. https://doi.org/10.1002/bjs.9764

    Article  PubMed  PubMed Central  Google Scholar 

  8. Kodera Y, Sano T (2017) Japanese gastric cancer treatment guidelines 2014 (ver. 4). Gastric Cancer 20:1–19. https://doi.org/10.1007/s10120-016-0622-4

    Article  Google Scholar 

  9. Katai H, Mizusawa J, Katayama H, Takagi M, Yoshikawa T, Fukagawa T, Terashima M, Misawa K, Teshima S, Koeda K, Nunobe S, Fukushima N, Yasuda T, Asao Y, Fujiwara Y, Sasako M (2016) Short-term surgical outcomes from a phase III study of laparoscopy-assisted versus open distal gastrectomy with nodal dissection for clinical stage IA/IB gastric cancer: Japan Clinical Oncology Group Study JCOG0912. Gastric Cancer. https://doi.org/10.1007/s10120-016-0646-9

    Article  PubMed  PubMed Central  Google Scholar 

  10. Inaki N, Etoh T, Ohyama T, Uchiyama K, Katada N, Koeda K, Yoshida K, Takagane A, Kojima K, Sakuramoto S, Shiraishi N, Kitano S (2015) A multi-institutional, prospective, phase II feasibility study of laparoscopy-assisted distal gastrectomy with D2 lymph node dissection for locally advanced gastric cancer (JLSSG0901). World J Surg 39:2734–2741. https://doi.org/10.1007/s00268-015-3160-z

    Article  PubMed  Google Scholar 

  11. Kim W, Kim HH, Han SU, Kim MC, Hyung WJ, Ryu SW, Cho GS, Kim CY, Yang HK, Park DJ, Song KY, Il LS, Ryu SY, Lee JH, Lee HJ (2016) Decreased morbidity of laparoscopic distal gastrectomy compared with open distal gastrectomy for stage I gastric cancer: Short-term outcomes from a multicenter randomized controlled trial (KLASS-01). Ann Surg 263:28–35. https://doi.org/10.1097/SLA.0000000000001346

    Article  PubMed  Google Scholar 

  12. Lee H-J, Hyung WJ, Yang H-K, Han SU, Park Y-K, An JY, Kim W, Kim H-I, Kim H-H, Ryu SW, Hur H, Kong S-H, Cho GS, Kim J-J, Park DJ, Ryu KW, Kim YW, Kim JW, Lee J-H, Kim M-C, Korean Laparo-endoscopic Gastrointestinal Surgery Study (KLASS) Group (2019) Short-term outcomes of a multicenter randomized controlled trial comparing laparoscopic distal gastrectomy with D2 lymphadenectomy to open distal gastrectomy for locally advanced gastric cancer (KLASS-02-RCT). Ann Surg XX:1–9. https://doi.org/10.1097/SLA.0000000000003217

  13. Kinoshita T, Uyama I, Terashima M, Noshiro H, Nagai E, Obama K, Tamamori Y, Nabae T, Honda M, Abe T, LOC-A Study Group (2018) Long-term outcomes of laparoscopic versus open surgery for clinical stage ii/iii gastric cancer: a multicenter cohort study in Japan (LOC-A Study). Ann Surg 264:214–222. https://doi.org/10.1097/SLA.0000000000002768

    Article  Google Scholar 

  14. Hyung WJ, Yang HK, Han SU, Lee YJ, Park JM, Kim JJ, Kwon OK, Kong SH, Il KH, Lee HJ, Kim W, Ryu SW, Jin SH, Oh SJ, Ryu KW, Kim MC, Ahn HS, Park YK, Kim YH, Hwang SH, Kim JW, Cho GS (2019) A feasibility study of laparoscopic total gastrectomy for clinical stage I gastric cancer: a prospective multi-center phase II clinical trial, KLASS 03. Gastric Cancer 22:214–222. https://doi.org/10.1007/s10120-018-0864-4

    Article  CAS  PubMed  Google Scholar 

  15. Katai H, Mizusawa J, Katayama H, Kunisaki C, Sakuramoto S, Inaki N, Kinoshita T, Iwasaki Y, Misawa K, Takiguchi N, Kaji M, Okitsu H, Yoshikawa T, Terashima M (2019) Single-arm confirmatory trial of laparoscopy-assisted total or proximal gastrectomy with nodal dissection for clinical stage I gastric cancer: Japan Clinical Oncology Group study JCOG1401. Gastric Cancer. https://doi.org/10.1007/s10120-019-00929-9

    Article  PubMed  Google Scholar 

  16. Hosogi H, Yoshimura F, Yamaura T, Satoh S, Uyama I, Kanaya S (2014) Esophagogastric tube reconstruction with stapled pseudo-fornix in laparoscopic proximal gastrectomy: a novel technique proposed for Siewert type II tumors. Langenbeck’s Arch Surg 399:517–523. https://doi.org/10.1007/s00423-014-1163-0

    Article  Google Scholar 

  17. Takiguchi S, Miyazaki Y, Shinno N, Makino T, Takahashi T, Kurokawa Y, Yamasaki M, Nakajima K, Miyata H, Mori M, Doki Y (2016) Laparoscopic mediastinal dissection via an open left diaphragm approach for advanced Siewert type II adenocarcinoma. Surg Today 46:129–134. https://doi.org/10.1007/s00595-015-1247-7

    Article  PubMed  Google Scholar 

  18. Kinoshita T, Gotohda N, Kato Y, Takahashi S, Konishi M, Okazumi S, Katoh R, Kinoshita T (2012) Laparoscopic transhiatal resection for siewert type II adenocarcinoma of the esophagogastric junction. Surg Laparosc Endosc Percutan Tech 22:e199–e203. https://doi.org/10.1097/SLE.0b013e31825a72e2

    Article  PubMed  Google Scholar 

  19. Sugita S, Kinoshita T, Kaito A, Watanabe M, Sunagawa H (2018) Short-term outcomes after laparoscopic versus open transhiatal resection of Siewert type II adenocarcinoma of the esophagogastric junction. Surg Endosc 32:383–390. https://doi.org/10.1007/s00464-017-5687-6

    Article  PubMed  Google Scholar 

  20. Huang C-M, Lv C-B, Lin J-X, Chen Q-Y, Zheng C-H, Li P, Xie J-W, Wang J-B, Lu J, Cao L-L, Lin M, Tu R-H (2016) Laparoscopic-assisted versus open total gastrectomy for Siewert type II and III esophagogastric junction carcinoma: a propensity score-matched case-control study. Surg Endosc. https://doi.org/10.1007/s00464-016-5375-y

    Article  PubMed  PubMed Central  Google Scholar 

  21. Zhao Y, Zhang J, Yang D, Tang Z, Wang Q (2019) Feasibility of laparoscopic total gastrectomy for advanced Siewert type II and type III esophagogastric junction carcinoma: a propensity score-matched case-control study. Asian J Surg. https://doi.org/10.1016/j.asjsur.2018.12.014

    Article  PubMed  Google Scholar 

  22. Shi Y, Li L, Xiao H, Guo S, Wang G, Tao K, Dong J, Zong L (2018) Feasibility of laparoscopic gastrectomy for patients with Siewert-type II/III adenocarcinoma of the esophagogastric junction: a propensity score matching analysis. PLoS ONE 13:1–10. https://doi.org/10.1371/journal.pone.0203125

    Article  CAS  Google Scholar 

  23. Sobin L, Gospodarowicz MWC (2009) TNM classification of malignant tumours, 7th edn. Wiley, New York

    Google Scholar 

  24. Sano T, Kodera Y (2011) Japanese classification of gastric carcinoma: 3rd English edition. Gastric Cancer 14:101–112. https://doi.org/10.1007/s10120-011-0041-5

    Article  Google Scholar 

  25. Dindo D, Demartines N, Clavien P-A (2004) Classification of surgical complications. Ann Surg 240:205–213. https://doi.org/10.1097/01.sla.0000133083.54934.ae

    Article  PubMed  PubMed Central  Google Scholar 

  26. Kurokawa Y, Takeuchi H, Doki Y, Mine S, Terashima M, Yasuda T, Yoshida K, Daiko H, Sakuramoto S, Yoshikawa T, Kunisaki C, Seto Y, Tamura S, Shimokawa T, Sano T, Kitagawa Y (2019) Mapping of lymph node metastasis from esophagogastric junction tumors A prospective nationwide multicenter study. Ann Surg. https://doi.org/10.1097/SLA.0000000000003499

    Article  PubMed  Google Scholar 

  27. Sasako M, Sakuramoto S, Katai H, Kinoshita T, Furukawa H, Yamaguchi T, Nashimoto A, Fujii M, Nakajima T, Ohashi Y (2011) Five-year outcomes of a randomized phase III trial comparing adjuvant chemotherapy with S-1 versus surgery alone in stage II or III gastric cancer. J Clin Oncol 29:4387–4393. https://doi.org/10.1200/JCO.2011.36.5908

    Article  CAS  PubMed  Google Scholar 

  28. Bang YJ, Kim YW, Yang HK, Chung HC, Park YK, Lee KH, Lee KW, Kim YH, Noh SI, Cho JY, Mok YJ, Kim YH, Ji J, Sen YT, Button P, Sirzén F, Noh SH (2012) Adjuvant capecitabine and oxaliplatin for gastric cancer after D2 gastrectomy (CLASSIC): a phase 3 open-label, randomised controlled trial. Lancet 379:315–321. https://doi.org/10.1016/S0140-6736(11)61873-4

    Article  CAS  PubMed  Google Scholar 

  29. Kaito A, Kinoshita T, Shitara K, Shibasaki H, Nishida T (2017) Timing of initiation of adjuvant chemotherapy for gastric cancer: a case-matched comparison study of laparoscopic vs. open surgery. Eur J Surg Oncol 43:801–807. https://doi.org/10.1016/j.ejso.2017.01.008

    Article  CAS  PubMed  Google Scholar 

  30. Fujitani K, Kurokawa Y, Takeno A, Endoh S, Ohmori T, Fujita J, Yamasaki M, Takiguchi S, Mori M, Doki Y (2018) Time to initiation or duration of S-1 adjuvant chemotherapy; which really impacts on survival in stage II and III gastric cancer? Gastric Cancer 21:446–452. https://doi.org/10.1007/s10120-017-0767-9

    Article  CAS  PubMed  Google Scholar 

  31. Nakanishi K, Kanda M, Ito S, Mochizuki Y, Teramoto H, Ishigure K, Murai T, Asada T, Ishiyama A, Matsushita H, Tanaka C, Kobayashi D, Fujiwara M, Murotani K, Kodera Y (2019) Delay in initiation of postoperative adjuvant chemotherapy with S-1 monotherapy and prognosis for gastric cancer patients: analysis of a multi-institutional dataset. Gastric Cancer. https://doi.org/10.1007/s10120-019-00961-9

    Article  PubMed  Google Scholar 

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Acknowledgements

We thank Edanz Group (www.edanzediting.com/ac) for editing a draft of this manuscript. We also thank Shogo Nomura from department of biostatistics, National Cancer Center Hospital East for advising us about statistical analysis.

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Authors and Affiliations

  1. Department of Gastric Surgery, National Cancer Center Hospital East, 6-5-1, Kashiwanoha, Kashiwa, Chiba, 277-8577, Japan

    Shizuki Sugita, Takahiro Kinoshita, Masanori Tokunaga, Akio Kaito, Masahiro Watanabe, Akiko Tonouchi & Reo Sato

  2. Division of Surgical Oncology, Department of Surgery, Nagoya University Graduate School of Medicine, Nagoya, Japan

    Shizuki Sugita, Masahiro Watanabe & Masato Nagino

  3. Department of Pathology and Clinical Laboratories, National Cancer Center Hospital East, Kashiwa, Japan

    Shizuki Sugita & Takeshi Kuwata

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  1. Shizuki Sugita
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Correspondence to Takahiro Kinoshita.

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Drs. Sugita, Kinoshita, Tokunaga, Kaito, Watanabe, Tonouchi, Sato, Kuwata, and Nagino do not have conflicts of interest or financial ties to disclose.

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Sugita, S., Kinoshita, T., Kuwata, T. et al. Long-term oncological outcomes of laparoscopic versus open transhiatal resection for patients with Siewert type II adenocarcinoma of the esophagogastric junction. Surg Endosc 35, 340–348 (2021). https://doi.org/10.1007/s00464-020-07406-w

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