The following is a summary of “Impact of the Surgical Approach for Neoadjuvantly Treated Gastroesophageal Junction Type II Tumors,” published in the November 2023 issue of Surgery by Wirsik, et al.
For a study, researchers sought to find out how well transhiatal gastrectomy (THG) or transthoracic esophagectomy (TTE) worked in treating GEJ Siewert type II adenocarcinomas after neoadjuvant chemotherapy. Researchers did an international, high-volume center cohort analysis to do this. Neoadjuvant radiochemotherapy or postoperative chemotherapy (CTx) is the usual treatment for GEJ that is locally advanced. It is followed by surgery. However, it still needs to be clarified what the best medical method is for type II GEJ tumors because the choice is mostly based on personal experience and an evaluation of the risk of surgery.
Five databases that are kept up to date prospectively were analyzed. From 2012 to 2021, 800 people with type II GEJ tumors and neoadjuvant radiochemotherapy or CTx met the inclusion conditions. The main goal was to find the median overall survival (mOS). Propensity score matching was used to reduce selection bias. These results show that patients undergoing THG (n=163, 20.4%) had higher ASA rating and cT stage (P<0.001) than patients undergoing TTE (n=637, 79.6%). Neoadjuvant treatment was different because most people in the THG group (87.1%, P<0.001) were getting CTx. In the TTE group, there was more tumor shrinkage (P=0.009), less ypT/ypM (both P<0.001), more nodal yield (P=0.009), and a higher rate of R0 removal (P=0.001).
The mOS was longer after TTE (78.0 months vs. 40.0 months, P=0.013). A higher R0 clearance rate (P=0.004) and the mOS benefit after TTE stayed the same (P=0.04). TTE’s survival benefit was seen in subgroup analyses of patients without distant cancer (P=0.037) and patients only after neoadjuvant treatment (P=0.021). TTE was a reliable indicator of longer life on its own. While waiting for the randomized CARDIA study results, TTE is the best method in centers with many patients because it has good oncologic outcomes.
