Published online Oct 8, 2015. doi: 10.4254/wjh.v7.i22.2411
Peer-review started: April 30, 2015
First decision: June 25, 2015
Revised: August 10, 2015
Accepted: September 10, 2015
Article in press: September 16, 2015
Published online: October 8, 2015
Processing time: 158 Days and 9.8 Hours
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, surgery protocols, 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.
Core tip: Esophagogastric junction cancers are rare tumors that have increased in prevalence in recent decades due to lifestyle changes. Key results of this study are as follows: (1) We describe a treatment for patients with esophago-gastric junction cancer; (2) We show the surgical details in high quality artwork to better represent the surgery; and (3) We show the postoperative and oncological outcomes of this technique.