Total meso-esophagogastrectomy in surgically resectable Siewert type II-III junctional gastric cancer: Safety and long term oncologic outcome
Journal Title: Journal of Cancer Research & Therapy - Year 2014, Vol 2, Issue 9
Abstract
Aim: To analyze our experience confronting meso-esophagogastric resection (transhiatally extended total gastrectomy en-bloc with its inviolate primitive dorsal and ventral mesenterium) to less radical planes of surgery (intra-mesoesophagogastric and muscularis propria planes), in the multimodal management of junctional Siewert II/III resectable gastric cancer. Methods: 138 patients with stage I-III/C type II-III Siewert junctional cancers were enrolled. Proximal and distal marginal clearance, closest meso-esophageal resection margin (CRM), volume in mm3 of meso-esophageal tissue around the tumor, R0 resections rate, number of lymph nodes harvested and five years overall and disease-free survival were recorded for each plane of surgery. Results: Mortality and morbidity were 3.6% and 22.4% respectively; operative length was 235 ± 23 min.; mean blood loss was 195 ± 53cc. Mean meso-esophageal tissue volume including tumor was 35,157 mm3 for meso-esophagogastric resections, 25,397 mm3 for intra-mesoesophagogastric resections and 20,531 mm3 for “muscularis propria” resections, all statistically significant (p < 0.05). Mean follow-up was 40.3 months. Five years overall survival was 52.2% for meso-esophagogastric resection, 45% for intra-mesoesophagogastric and 35.2% for muscularis propria resections, all statistically significant; the difference was particularly enhanced in stage II-IIIA/B (56.2%, 47.8% and 30% for meso-esophagogastric, intra-meso-esophagogastric and muscularis propria planes respectively). On multivariate analysis, meso-esophagogastric plane of resection, pCR after neo-adjuvant chemo-radiation, R0, CRM > 1mm and pN0 were associated with increased recurrence-free survival. Conclusions: When compared to less extensive planes of surgery, transhiatally extended total meso-esophagogastrectomy confers a survival advantage in the intermediate stages of Siewert type II-III junctional gastric cancer, increasing R0 resection rate, decreasing CRM < 1mm and enhancing lymph node harvesting, with consequent impact on loco-regional control and survival; differently, in the extreme stages (I and IIIC N + patients), total meso-esophagogastrectomy is ineffective in altering the standard oncologic outcome. In our experience, total meso-esophagogastrectomy proved to be safe and oncologically effective, especially in stage II-IIIA/B, representing a pivotal part of multimodal management of type II/III EGJ cancers.
Authors and Affiliations
Siani LM
Keywords
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- EP ID EP548552
- DOI 10.14312/2052-4994.2014-23
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Total meso-esophagogastrectomy in surgically resectable Siewert type II-III junctional gastric cancer: Safety and long term oncologic outcome
Aim: To analyze our experience confronting meso-esophagogastric resection (transhiatally extended total gastrectomy en-bloc with its inviolate primitive dorsal and ventral mesenterium) to less radical planes of surgery (...