Takeda FR, Obregon CA, Navarro YP, Moura DTH, Ribeiro Jr U, Aissar Sallum RA, Cecconello I. Thoracoscopic esophagectomy is related to better outcomes in early adenocarcinoma of esophagogastric junction tumors. World J Gastrointest Endosc 2021; 13(8): 319-328 [PMID: 34512879 DOI: 10.4253/wjge.v13.i8.319]
Corresponding Author of This Article
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
Research Domain of This Article
Surgery
Article-Type of This Article
Retrospective Study
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Takeda FR, Obregon CA, Navarro YP, Moura DTH, Ribeiro Jr U, Aissar Sallum RA, Cecconello I. Thoracoscopic esophagectomy is related to better outcomes in early adenocarcinoma of esophagogastric junction tumors. World J Gastrointest Endosc 2021; 13(8): 319-328 [PMID: 34512879 DOI: 10.4253/wjge.v13.i8.319]
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.
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
ARTICLE HIGHLIGHTS
Research background
Extension of lymphadenectomy during esophagectomy is on debate for adenocarcinoma of the esophagogastric junction. Thoracoscopic transthoracic access is consider superior regarding retrieved lymphonodes comparing to transhiatal esophagectomy, but overall survival is questionable.
Research motivation
To understand the relationship between extension of lymphadenectomy and survival according to type of surgical approach.
Research objectives
To compare outcomes after thoracoscopic esophagectomy and transhiatal approach for adenocarcinoma of the esophagogastric junction.
Research methods
Retrospective review of medical records of patients were assessed. A total of 147 patients with adenocarcinoma of the esophagogastric junction were selected from 2002 to 2019, and divided into group A (thoracoscopic esophagectomy), and group B (transhiatal esophagectomy). Overall survival (OS), disease-free survival, postoperative complications, and number of nodes, were similarly evaluated.
Research results
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.
Research conclusions
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.
Research perspectives
Prospective randomized trials addressing topics as long-term survival, the role of neoadjuvant therapies and costs.
