Total esophagogastrectomy plus extended lymphadenectomy with transverse colon interposition:A treatment for extensive esophagogastric junction cancer

AIM:To review the post-operative morbidity and mortality of total esophagogastrectomy(TEG) with second barrier lymphadenectomy(D2) with interposition of a transverse colon and to determine the oncological outcomes of TEG D2 with interposition of a transverse colon.METHODS:This study consisted of a retrospective review of patients with a cancer diagnosis who underwent TEG between 1997 and 2013. Demographic data,surgeryprotocols,complications according to Clavien-Dindo classifications,final pathological reports,oncological follow-ups and causes of death were recorded. We used the TNM 2010 and Japanese classifications for nodal dissection of gastric cancer. We used descriptive statistical analysis and Kaplan-Meier survival curves. A P-value of less than 0.05 was considered statistically significant.RESULTS:The series consisted of 21 patients(80.9% men). The median age was 60 years. The 2 main surgical indications were extensive esophagogastric junction cancers(85.7%) and double cancers(14.2%). The mean total surgery time was 405 min(352-465 min). Interposition of a transverse colon through the posterior mediastinum was used for replacement in all cases. Splenectomy was required in 13 patients(61.9%),distal pancreatectomy was required in 2 patients(9.5%) and resection of the left adrenal gland was required in 1 patient(4.7%). No residual cancer surgery was achieved in 75.1% of patients. A total of 71.4% of patients had a postoperative complication. Respiratory complications were the most frequently observed complication. Postoperative mortality was 5.8%. Median follow-up was 13.4 mo. Surgery specific survival at 5 years of follow-up was 32.8%; for patients with curative surgery,it was 39.5% at 5 years.CONCLUSION:TEG for cancer with interposition of a transverse colon is a very complex surgery,and it presents high post-operative morbidity and adequate oncological outcomes.

The effect of disc-shaped gastric resection of anastomosis site on reducing postoperative dysphagia and stricture after esophagogastric anastomosis in patients with esophageal cancer

Background:Esophagectomy remains the most reliable technique for managing esophageal cancer,but anastomotic complications including postoperative leak,ischemia and stricture negatively affect outcomes of this specific surgery.The aim of this study was to evaluate the effects of a novel method of esophagogastric anastomosis for reducing postoperative dysphagia and stricture formation.Methods:Eighty patients who were scheduled for esophagectomy due to esophageal cancer were randomly assigned into two groups:intervention and control(40 each).In the control group,the esophagogastric anastomosis was performed with a linear gastric incision,whilst in the intervention group a new method of disc-shaped gastric resection for anastomosis was applied.Postoperative outcomes were compared between the two groups.Results:The incidence of postoperative dysphagia and anastomotic stricture was significantly lower in the disc-shaped resection group(dysphagia 45%vs 75%,P=0.02;stricture 12.5%vs 32.5%,P=0.03),whilst the length of stay in an intensive care unit(ICU),anastomotic leakage and other complications were not significantly different between the two groups(all P>0.05).Conclusion:Anastomotic complications can be reduced by improving surgical techniques.The decreased incidence of postoperative dysphagia and anastomotic stricture in our study may be partly due to providing the proper diameter for the site of anastomosis when using the disc-shaped gastric resection method.Hence,this new method can improve the clinical outcomes of patients who undergo esophagectomy with esophagogastric anastomosis.