The Postoperative outcomes of thoracoscopic-laparoscopic Ivor-Lewis surgery plus D2 celiac lymphadenectomy for patients
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and Other Interventional Techniques
The Postoperative outcomes of thoracoscopic‑laparoscopic Ivor‑Lewis surgery plus D2 celiac lymphadenectomy for patients with adenocarcinoma of the esophagogastric junction Kun‑Kun Li1 · Tao Bao1 · Ying‑Jian Wang1 · Xue‑Hai Liu1 · Wei Guo1 Received: 12 July 2019 / Accepted: 28 November 2019 © Springer Science+Business Media, LLC, part of Springer Nature 2019
Abstract Objectives Adenocarcinoma of the esophagogastric junction (AEG) is one of the most aggressive and poor prognosis cancers. To date, no standard procedures have been established for the surgical treatment of Siewert type II. In this study, we proposed the approach of thoracoscopic-laparoscopic Ivor-Lewis surgery plus D2 celiac lymphadenectomy (TLILD2) and aimed to investigate the patterns of lymph node metastasis and long-term survival. Methods From June 2015 to June 2018, 72 patients accepted TLILD2 and enrolled in this study. Relevant patient characteristics and postoperative variables were collected and evaluated. The disease-free survival (DFS) and disease-specific survival (DSS) were determined by the Kaplan–Meier method and compared by log-rank tests. Results There was no case of postoperative death in this study, and the most common complication was anastomotic mediastinal fistula (5/72, 6.9%). A total of 2811 lymph nodes were retrieved, and the positivity rate was 11.9% (334/2811). The positivity rate of celiac and mediastinal lymph nodes was 14.4% (314/2186) and 3.2% (20/625), respectively. The percentage of patients who had positive celiac and mediastinal lymph nodes reached up to 58.3% (42/72) and 8.3% (6/72), respectively. The DFS and DSS of these 72 patients were 94% and 93.4% at 1 year after surgery and 59.8% and 62% at 3 years after surgery, respectively. The pTNM stage showed a significant difference between DFS and DSS. Conclusions TLILD2 could be a potential way to promote long-term survival of AEG patients. On the basis of the patterns of lymph nodes metastasis, we suggest that lower mediastinal and D2 celiac lymphadenectomy is necessary to improve the oncological outcome. Keywords Adenocarcinoma of the esophagogastric junction · Thoracoscopic-laparoscopic · Ivor-Lewis · D2 celiac lymphadenectomy · Survival Adenocarcinoma of the esophagogastric junction (AEG) is one of the most aggressive and poor prognosis cancers, and an increase in the incidence of AEG has been observed worldwide during the past decades [1, 2]. This entity is classified according to Siewert classification into three types in terms of localization relative to the esophagogastric junction (EGJ) [3], and the prognosis of patients with type I and II tumors was significantly better than that of patients with type III tumors [3]. AEG type I tumors are adenocarcinomas of the distal esophagus with the
* Wei Guo [email protected] 1
Department of Thoracic Surgery, Daping Hospital, Army Medical University, Chongqing 400042, People’s Republic of China
center located within 1 cm and 5 cm above the anatomic EGJ [4], AEG type II
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