title: The impact of operative approach on outcome of surgery for gastro-oesophageal tumours.
abstract: BACKGROUND
  The choice of operation for tumours at or around the gastro-oesophageal junction remains controversial with little evidence to support one technique over another. This study examines the prevalence of margin involvement and nodal disease and their impact on outcome following three surgical approaches (Ivor Lewis, transhiatal and left thoraco-laparotomy) for these tumours.
  
  
  METHODS
  A retrospective analysis was conducted of patients undergoing surgery for distal oesophageal and gastro-oesophageal junction tumours by a single surgeon over ten years. Comparisons were undertaken in terms of tumour clearance, nodal yield, postoperative morbidity, mortality, and median survival. All patients were followed up until death or the end of the data collection (mean follow up 33.2 months).
  
  
  RESULTS
  A total of 104 patients were operated on of which 102 underwent resection (98%). Median age was 64.1 yrs (range 32.1-79.4) with 77 males and 25 females. Procedures included 29 Ivor Lewis, 31 transhiatal and 42 left-thoraco-laparotomies. Postoperative mortality was 2.9% and median survival 23 months. Margin involvement was 24.1% (two distal, one proximal and 17 circumferential margins). Operative approach had no significant effect on nodal clearance, margin involvement, postoperative mortality or morbidity and survival. Lymph node positive disease had a significantly worse median survival of 15.8 months compared to 39.7 months for node negative (p = 0.007), irrespective of approach.
  
  
  CONCLUSIONS
  Surgical approach had no effect on postoperative mortality, circumferential tumour, nodal clearance or survival. This suggests that the choice of operative approach for tumours at the gastro-oesophageal junction may be based on the individual patient and tumour location rather than surgical dogma.
authors: Department of Surgery, Ward 33, Aberdeen Royal Infirmary, Foresterhill, Aberdeen, AB25 2ZN, UK. Ken.Park@arh.grampian.scot.nhs.uk.
authors: Stuart A
authors: SA
authors: Suttie
authors: Alan Gk
authors: AG
authors: Li
authors: Martha
authors: M
authors: Quinn
authors: Kenneth Gm
authors: KG
authors: Park
references: Arch Surg. 2004 Jun;139(6):627-31; discussion 631-3
references: 15197089
references: Ann Surg. 1994 Sep;220(3):364-72; discussion 372-3
references: 8092902
references: Endoscopy. 1993 Nov;25(9):660-3
references: 8119227
references: World J Surg. 1999 Mar;23(3):271-5; discussion 275-6
references: 9933699
references: Dis Esophagus. 2001;14(2):104-9
references: 11553218
references: J Thorac Cardiovasc Surg. 1993 Nov;106(5):850-8; discussion 858-9
references: 8231207
references: Br J Cancer. 1999 May;80(5-6):834-42
references: 10360663
references: J Thorac Cardiovasc Surg. 1986 Feb;91(2):242-7
references: 3945092
references: Eur J Surg Oncol. 2004 Apr;30(3):313-7
references: 15028315
references: Br J Surg. 2004 Aug;91(8):943-7
references: 15286953
references: Aust N Z J Surg. 1999 Mar;69(3):187-94
references: 10075357
references: Br J Surg. 1998 Nov;85(11):1457-9
references: 9823902
references: J Clin Oncol. 2004 Jun 1;22(11):2069-77
references: 15082726
references: Lancet. 2002 May 18;359(9319):1727-33
references: 12049861
references: Am J Surg. 1998 Sep;176(3):286-90
references: 9776161
references: ANZ J Surg. 2005 Dec;75(12):1045-8
references: 16398807
references: Am J Surg. 1996 Nov;172(5):478-81; discussion 481-2
references: 8942548
references: Gut. 2001 May;48(5):667-70
references: 11302966
references: Br J Surg. 1990 Jul;77(7):815-9
references: 1696513
references: N Engl J Med. 2002 Nov 21;347(21):1662-9
references: 12444180
references: J Am Coll Surg. 2004 Dec;199(6):880-6
references: 15555971
references: Am J Surg. 1997 Sep;174(3):320-4
references: 9324146
references: Br J Surg. 1993 Mar;80(3):367-70
references: 8472154
references: Lancet Oncol. 2006 Aug;7(8):644-51
references: 16887481
references: Am J Surg. 1998 May;175(5):422-5
references: 9600292
references: Br J Cancer. 2003 May 19;88(10):1549-52
references: 12771920