title: Technical aspects and results of the transhiatal resection in adenocarcinomas of the gastroesophageal junction.
abstract: The distribution of lymph node metastases of adenocarcinomas of the gastroesophageal junction is classified into three types. The R0 resection with complete lymphadenectomy therefore requires different resection methods for type 1 and type 2/3 tumors. Comparing the subtotal esophagectomy and the extended gastrectomy, no advantage in survival can be seen for one method or one tumor type (type 1 or type 2/3). The same is true for the lethality. Indeed, the transhiatal resection is accompanied by a higher complication rate. However, the different operation methods for cardiacarcinomas, with subtotal esophagectomy in type 1 and extended gastrectomy in type 2/3 tumors, should be maintained because of increased rates of local recurrence that may be expected if all cardiacarcinoma types were treated using subtotal esophagectomy with gastric tube interposition. Therefore, we suggest a subtotal esophagectomy only in type 1 tumors. In type 2/3 tumors, an extended gastrectomy with resection of the distal esophagus, lymphadenectomy of the lower mediastinum, and D2 lymphadenectomy should be performed.
authors.affiliation: Department of Surgery, Townhospital Düsseldorf Gerresheim, Düsseldorf, Germany. Prof.Ulrich@Kliniken-Duesseldorf.de
authors.forename: B
authors.initials: B
authors.lastname: Ulrich
authors.forename: A
authors.initials: A
authors.lastname: Zahedi
mesh_terms: D000230:Adenocarcinoma / Q000473:pathology / Q000601:surgery*; D004938:Esophageal Neoplasms / Q000473:pathology / Q000601:surgery*; D016629:Esophagectomy / Q000379:methods*; D004943:Esophagogastric Junction / Q000473:pathology / Q000601:surgery*; D006801:Humans; D008207:Lymphatic Metastasis; D009364:Neoplasm Recurrence, Local; D009367:Neoplasm Staging; D011183:Postoperative Complications; D013274:Stomach Neoplasms / Q000473:pathology / Q000601:surgery*; D015996:Survival Rate