IMPACT OF SURGICAL APPROACH ON IMMEDIATE AND LONGTERM RESULTS FOR PATIENTS WITH ADVANCED LOCAL ESOPHAGOGASTRIC JUNCTION ADENOCARCINOMA

C. Marica; Rodica Bîrlă; Raluca Marica; Eugenia Panaitescu; Laura Carstocea; S. Constantinoiu

doi:10.33695/jss.v5i2.154

C. Marica General Surgery Departament, „Sf. Maria” Clinical Hospital, Bucharest, Romania; “Carol Davila” University of Medicine and Pharmacy, Bucharest, Romania
Rodica Bîrlă General Surgery Departament, „Sf. Maria” Clinical Hospital, Bucharest, Romania; “Carol Davila” University of Medicine and Pharmacy, Bucharest, Romania
Raluca Marica General Surgery Departament, „Sf. Maria” Clinical Hospital, Bucharest, Romania; “Carol Davila” University of Medicine and Pharmacy, Bucharest, Romania
Eugenia Panaitescu “Carol Davila” University of Medicine and Pharmacy, Bucharest, Romania
Laura Carstocea “Carol Davila” University of Medicine and Pharmacy, Bucharest, Romania
S. Constantinoiu General Surgery Departament, „Sf. Maria” Clinical Hospital, Bucharest, Romania; “Carol Davila” University of Medicine and Pharmacy, Bucharest, Romania

DOI: https://doi.org/10.33695/jss.v5i2.154

Keywords: Esophagogastric junction, adenocarcinoma, surgical approach

Abstract

Due to the localization of these tumors at the border between the stomach and the esophagus, the optimal surgical strategy for patients with adenocarcinoma of the esophagus junction is controversial. Evaluation of the influence of surgical approach on immediate and longterm results for patients with adenocarcinoma of esophagogastric junction. Between 2010-2017, 62 patients with locally advanced gastroesophageal junction adenocarcinomas were treated at St. Mary Hospital. The surgical approach was: abdominal in 40 patients – mainly for patients with Siewert type III - 72.5%. Other types of surgical approach: abdominocervical in 4 patients, abdominothoracic - 5 patients, triple approach in 5 patients were mainly used for patients with Siewert type I (11 patients). Patients with Siewert type II had either abdominal (11 patients) or combined (7 patients). Postoperative morbidity was 46.77%. Anastomotic fistula occurred in 17 patients as follow: after abdominal approach in 10 patients, 2 patients after abdomino cervical approach, 2 patients after abdominothoracic approach, and 3 patients after triple approach. Postoperative mortality was 4.8%. The late complications were anastomotic stenosis in 14 patients. Anastomotic tumor recurrence was diagnosed in 7 patients. Survival analysis shows different survival curves in the way that the abdominocervical approach led to a reduced survival rate: 0% at 24 months, while the triple approach recorded a superior survival, 50% at 5 years. Intermediate curves I noticed after abdominal approach with 52.56% survival rate and 46.2% for abdominothoracic approach. Patients operated using abdominal approach had a significantly different mortality compared to patients operated by combined approach. The surgical approach did not influence the occurrence of postoperative complications - anastomotic fistula, fistula severity or pulmonary complications.