Technical aspects and results of the transhiatal resection in adenocarcinomas of the gastroesophageal junction

Abstract

The distribution of lymph node metastases of adenocarcinomas of the gastroesophageal junction is classified into three types. The R0 resection with complete lymphadenectomy therefore requires different resection methods for type 1 and type 2/3 tumors. Comparing the subtotal esophagectomy and the extended gastrectomy, no advantage in survival can be seen for one method or one tumor type (type 1 or type 2/3). The same is true for the lethality. Indeed, the transhiatal resection is accompanied by a higher complication rate. However, the different operation methods for cardiocarcinomas, with subtotal esophagectomy in type 1 and extended gastrectomy in type 2/3 tumors, should be maintained because of increased rates of local recurrence that may be expected if all cardiacarcinoma types were treated using subtotal esophagectomy with gastric tube interposition. Therefore, we suggest a subtotal esophagectomy only in type 1 tumors. In type 2/3 tumors, an extended gastrectomy with resection of the distal esophagus, lymphadenectomy of the lower mediastinum, and D2 lymphadenectomy should be performed.