Retrospective Study
Copyright ©The Author(s) 2021. Published by Baishideng Publishing Group Inc. All rights reserved.
World J Gastrointest Endosc. Aug 16, 2021; 13(8): 319-328
Published online Aug 16, 2021. doi: 10.4253/wjge.v13.i8.319
Thoracoscopic esophagectomy is related to better outcomes in early adenocarcinoma of esophagogastric junction tumors
Flavio Roberto Takeda, Carlos de Almeida Obregon, Yasmin Peres Navarro, Diogo Turiani Hourneaux Moura, Ulysses Ribeiro Jr, Rubens Antonio Aissar Sallum, Ivan Cecconello
Flavio Roberto Takeda, Carlos de Almeida Obregon, Yasmin Peres Navarro, Diogo Turiani Hourneaux Moura, Ulysses Ribeiro Jr, Rubens Antonio Aissar Sallum, Ivan Cecconello, Department of Gastroenterology, University of São Paulo Medical School, São Paulo 05403-000, Brazil
Author contributions: Takeda FR did acquisition of data, analysis, interpretation of data, drafting the article, revising the article, final approval; Obregon CA, Ribeiro Jr U and Sallum RAA did analysis and interpretation of data, revising the article; Navarro, YP: analysis and interpretation of data, revising the article; de Moura DTH and Cecconello I analysis of data, interpretation of data, drafting the article, revising the article, final approval.
Institutional review board statement: This is a retrospective review performed at Hospital das Clínicas da Faculdade de Medicina da Universidade de São Paulo and Instituto do Câncer do Estado de São Paulo (ICESP). As this is a retrospective analysis, the Ethics committee of both institutions exempted the need for approval.
Informed consent statement: Informed written consent was obtained from the patient for publication of this report and any accompanying images.
Conflict-of-interest statement: All authors deny any conflict of interest.
Data sharing statement: Consent was not obtained but the presented data are anonymized and risk of identification is low.
Open-Access: This article is an open-access article that was selected by an in-house editor and fully peer-reviewed by external reviewers. It is distributed in accordance with the Creative Commons Attribution NonCommercial (CC BY-NC 4.0) license, which permits others to distribute, remix, adapt, build upon this work non-commercially, and license their derivative works on different terms, provided the original work is properly cited and the use is non-commercial. See: http://creativecommons.org/Licenses/by-nc/4.0/
Corresponding author: Diogo Turiani Hourneaux Moura, MD, MSc, PhD, Associate Professor, Department of Gastroenterology, University of São Paulo Medical School, Av Doutor Enéas Carvalho de Aguiar, 255, São Paulo 05403-000, Brazil. dthmoura@hotmail.com
Received: February 18, 2021
Peer-review started: February 18, 2021
First decision: March 14, 2021
Revised: March 21, 2021
Accepted: July 14, 2021
Article in press: July 14, 2021
Published online: August 16, 2021
Processing time: 174 Days and 23.2 Hours
Abstract
BACKGROUND

Thoracoscopic esophagectomy is related to an extended lymphadenectomy, and a high number of retrieved lymph nodes, compared to the transhiatal approach; however, its association with an improvement in overall survival (OS) is debatable.

AIM

To compare thoracoscopic esophagectomy with transhiatal esophagectomy in patients with adenocarcinoma of the esophagogastric junction (AEGJ) in terms of survival, number of lymph nodes, and complications.

METHODS

In total, 147 patients with AEGJ were selected retrospectively from 2002 to 2019, and divided into Group A for thoracoscopic esophagectomy, and group B for transhiatal esophagectomy. OS, disease-free survival, postoperative complications, and number of nodes, were similarly evaluated.

RESULTS

One hundred and thirty (88%) were male; the mean age was 64 years. Group A had a mean age of 61.1 years and group B 65.7 years (P = 0.009). Concerning the extent of lymphadenectomy, group A showed a higher number of retrieved lymph nodes (mean of 31.89 ± 8.2 vs 20.73 ± 7; P < 0.001), with more perioperative complications, such as hoarseness, surgical site infections, and respiratory complications. Although both groups had similar OS rates, subgroup analysis showed better survival of transthoracic esophagectomy in patients with earlier diseases.

CONCLUSION

Both methods are safe, having similar morbidity and mortality rates. Transthoracic thoracoscopic esophagectomy allows a more extensive resection of the lymph nodes and may have better oncological outcomes during earlier stages of the disease. Prospective studies are warranted to better evaluate these findings.

Keywords: Adenocarcinoma; Esophagogastric junction; Transhiatal; Thoracoscopic; Lymph nodes; Surgery

Core Tip: The type of access during esophagectomy to adenocarcinoma of esophagogastric junction tumor is on debate. Thoracoscopic esophagectomy produces higher numbers of retrieved lymph nodes than transhiatal esophagectomy but is associated with more perioperative complications. The relationship between lymphadenectomy’s extension and survival outcomes is debatable. We compared both access and found better survival in early staging of patients treated by thoracoscopic esophagectomy, probably due to the extension of lymphadenectomy and acceptable complication rate. These findings reveal a new place of thoracoscopic esophagectomy for adenocarcinoma of the esophagogastric junction tumor in the multimodal era.