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©The Author(s) 2015. Published by Baishideng Publishing Group Inc. All rights reserved.
Total esophagogastrectomy plus extended lymphadenectomy with transverse colon interposition: A treatment for extensive esophagogastric junction cancer
Marco Ceroni, Enrique Norero, Juan Pablo Henríquez, Eduardo Viñuela, Eduardo Briceño, Cristian Martínez, Gloria Aguayo, Fernando Araos, Paulina González, Alfonso Díaz, Mario Caracci
Marco Ceroni, Enrique Norero, Juan Pablo Henríquez, Eduardo Viñuela, Eduardo Briceño, Cristian Martínez, Gloria Aguayo, Alfonso Díaz, Mario Caracci, Department of Digestive Surgery, Pontificia Universidad Católica de Chile School of Medicine, Hospital Sótero del Rio, Puente Alto, Santiago 8207257, Chile
Gloria Aguayo, Pathological Anatomy Department, Hospital Sótero del Rio, Puente Alto, Santiago 8207257, Chile
Fernando Araos, Radiology Department, Hospital Sótero del Rio, Puente Alto, Santiago 8207257, Chile
Paulina González, Research Nurse, Hospital Sótero del Rio, Puente Alto, Santiago 8207257, Chile
Author contributions: Ceroni M is the principal author; Ceroni M, Norero E, Henríquez JP, Viñuela E, Briceño E and Martínez C designed the research; Ceroni M, Norero E, Viñuela E, Briceño E, Aguayo G, Araos F, González P, Díaz A and Caracci M performed the research; Ceroni M contributed new reagents/analytic tools; Ceroni M analyzed the data; Ceroni M and Norero E wrote the paper.
Institutional review board statement: This study was reviewed and approved by the Ethics Committee of the Sotero del Rio Hospital.
Informed consent statement: All study participants, or their legal guardian, provided informed written consent prior to study enrollment.
Conflict-of-interest statement: We have no financial relationships to disclose.
Data sharing statement: Technical appendix, statistical code, and dataset available from the corresponding author at marco.ceroni@gmail.com. Consent was not obtained but the presented data are anonymized and risk of identification is low. No additional data are available.
Open-Access: This article is an open-access article which was selected by an in-house editor and fully peer-reviewed by external reviewers. It is distributed in accordance with the Creative Commons Attribution Non Commercial (CC BY-NC 4.0) license, which permits others to distribute, remix, adapt, build upon this work non-commercially, and license their derivative works on different terms, provided the original work is properly cited and the use is non-commercial. See: http://creativecommons.org/licenses/by-nc/4.0/
Correspondence to: Marco Ceroni, MD, Assistant Instructor, Department of Digestive Surgery, Pontificia Universidad Católica de Chile School of Medicine, Hospital Sótero del Rio, Avenida Concha y Toro 3459, Puente Alto, Santiago 8207257, Chile. marco.ceroni@gmail.com
Telephone: +56-9-65883214
Received: April 27, 2015
Peer-review started: April 30, 2015
First decision: June 25, 2015
Revised: August 10, 2015
Accepted: September 10, 2015
Article in press: September 16, 2015
Published online: October 8, 2015
AIM: To review the post-operative morbidity and mortality of total esophagogastrectomy (TEG) with second barrier lymphadenectomy (D2) with interposition of a transverse colon and to determine the oncological outcomes of TEG D2 with interposition of a transverse colon.
METHODS: This study consisted of a retrospective review of patients with a cancer diagnosis who underwent TEG between 1997 and 2013. Demographic data, surgery protocols, complications according to Clavien-Dindo classifications, final pathological reports, oncological follow-ups and causes of death were recorded. We used the TNM 2010 and Japanese classifications for nodal dissection of gastric cancer. We used descriptive statistical analysis and Kaplan-Meier survival curves. A P-value of less than 0.05 was considered statistically significant.
RESULTS: The series consisted of 21 patients (80.9% men). The median age was 60 years. The 2 main surgical indications were extensive esophagogastric junction cancers (85.7%) and double cancers (14.2%). The mean total surgery time was 405 min (352-465 min). Interposition of a transverse colon through the posterior mediastinum was used for replacement in all cases. Splenectomy was required in 13 patients (61.9%), distal pancreatectomy was required in 2 patients (9.5%) and resection of the left adrenal gland was required in 1 patient (4.7%). No residual cancer surgery was achieved in 75.1% of patients. A total of 71.4% of patients had a postoperative complication. Respiratory complications were the most frequently observed complication. Postoperative mortality was 5.8%. Median follow-up was 13.4 mo. Surgery specific survival at 5 years of follow-up was 32.8%; for patients with curative surgery, it was 39.5% at 5 years.
CONCLUSION: TEG for cancer with interposition of a transverse colon is a very complex surgery, and it presents high post-operative morbidity and adequate oncological outcomes.
Core tip: Esophagogastric junction cancers are rare tumors that have increased in prevalence in recent decades due to lifestyle changes. Key results of this study are as follows: (1) We describe a treatment for patients with esophago-gastric junction cancer; (2) We show the surgical details in high quality artwork to better represent the surgery; and (3) We show the postoperative and oncological outcomes of this technique.
