Oesophagectomy or Total Gastrectomy for the Management of Siewert II Gastroesophageal Junction Cancer: a Systematic Review and Meta-analysis

• Published in: Journal of gastrointestinal surgery 2023-07, Vol.27 (7), p.1321-1335
• Main Authors: Walmsley, James, Ariyarathenam, Arun, Berrisford, Richard, Humphreys, Lee, Sanders, Grant, Tham, Ji Chung, Wheatley, Tim, Chan, David S.Y.
• Format: Article
• Language: English
• Subjects: Adenocarcinoma - surgery; Anastomotic Leak - surgery; Esophageal cancer; Esophageal Neoplasms - surgery; Esophagectomy - methods; Esophagogastric Junction - surgery; Gastrectomy - methods; Gastric cancer; Gastroenterology; Gastrointestinal surgery; Humans; Medicine; Medicine & Public Health; Meta-analysis; Mortality; Original Article; Retrospective Studies; Stomach Neoplasms - surgery; Surgery; Surgical anastomosis; Systematic review
• ISSN: 1091-255X; 1873-4626
• DOI: 10.1007/s11605-023-05661-5

Background There is no consensus on the ideal surgical management of patients with Siewert type II gastroesophageal junctional (GEJ) cancers. Due to its anatomical location, total gastrectomy and oesophagectomy are widely used methods of resection. The aim of this study was to determine the optimal surgical treatment of these patients. Method A systematic search of PubMed, Medline and Cochrane libraries was conducted for literature published between 2000 and 2022. Studies directly comparing oesophagectomy to gastrectomy for Siewert type II tumours were included. Outcome measures included rates of anastomotic leak, 30-day mortality, R0 resection and 5-year survival. Statistical analysis was performed using Review Manager 5.4. Results Eleven studies involving 18,585 patients undergoing either oesophagectomy ( n = 8618) or total gastrectomy ( n = 9967) for Siewert type II GEJ cancer were included. There were no significant differences between the rates of anastomotic leak (OR 0.91, CI 0.59–1.40, p = 0.66) and R0 resection (OR 1.51, CI 0.93–2.42, p = 0.09). Patients undergoing total gastrectomy had a lower 30-day mortality (OR 0.66, CI 0.45–0.95, p = 0.03) and a greater 5-year overall survival (OR 1.49, CI 1.34–1.67, p < 0.001) compared to patients undergoing oesophagectomy. These differences were not statistically significant after excluding two large studies, which accounted for the majority of the total population in the analysis. Conclusion These results suggest that total gastrectomy results in lower 30-day mortality and improved overall survival in patients with Siewert type II GEJ cancer. However, interpretation of these results may be biased by the effect of two large studies.