Thoracoscopic esophagectomy is related to better outcomes in early adenocarcinoma of esophagogastric junction tumors

• Published in: World journal of gastrointestinal endoscopy 2021-08, Vol.13 (8), p.319-328
• Main Authors: Takeda, Flavio Roberto, Obregon, Carlos de Almeida, Navarro, Yasmin Peres, Moura, Diogo Turiani Hourneaux, Ribeiro Jr, Ulysses, Aissar Sallum, Rubens Antonio, Cecconello, Ivan
• Format: Article
• Language: English
• Subjects: Retrospective Study
• ISSN: 1948-5190; 1948-5190
• DOI: 10.4253/wjge.v13.i8.319

BACKGROUNDThoracoscopic 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. AIMTo 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. METHODSIn 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. RESULTSOne 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. CONCLUSIONBoth 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.