Surgical approaches to invasive adenocarcinoma of the gastroesophageal junction. Review uri icon

Overview

abstract

  • Despite a plethora of data, the optimal surgical approach to invasive adenocarcinoma of the gastroesophageal (GE) junction remains controversial. To quote Dr. Valerie Rusch, "Strong individual preferences and some degree of surgical mystique often govern the selection of operation for resection of GE junction adenocarcinomas."1 The fırst of these controversies is whether the optimal open surgical approach should be via the transabdominal, transthoracic (two-incision Ivor Lewis or three-incision McKeown), or transhiatal route. Proponents of the transthoracic or transhiatal routes have voiced strong opinions on the potential advantages and disadvantages of each approach (Table 1). It is clear from most large retrospective series that, in experienced hands, excellent results can be achieved by either approach. The principal advantage of the transthoracic route is the ability to perform a radical mediastinal lymphadenectomy en bloc with the primary tumor, the theory being that a more aggressive lymph node dissection would be associated with an improved long-term outcome. To date, however, this association of a more aggressive lymphadenectomy with improved outcome has remained elusive in most gastrointestinal malignancies, including esophageal cancer. Proponents of the transhiatal approach cite similar lymph node retrieval rates, the potential for lower short-term morbidity, and the potential for similar long-term outcomes.2 With the advent of newer technology, the controversy regarding the optimal surgical approach to adenocarcinoma of the GE junction has evolved in yet another direction, with proponents of a minimally invasive approach, citing even lower perioperative morbidity and mortality, again with comparable or even superior long-term oncologic results.

publication date

  • January 1, 2013

Research

keywords

  • Adenocarcinoma
  • Esophageal Neoplasms
  • Esophagectomy
  • Esophagogastric Junction
  • Stomach Neoplasms

Identity

Scopus Document Identifier

  • 84946198225

Digital Object Identifier (DOI)

  • 10.14694/EdBook_AM.2013.33.e144

PubMed ID

  • 23714483

Additional Document Info