title: Laparoscopic transhiatal resection for Siewert type II adenocarcinoma of the esophagogastric junction: operative technique and initial results.
abstract: Laparoscopic distal gastrectomy has gained wide acceptance, and laparoscopic total gastrectomy (LTG) and laparoscopic proximal gastrectomy (LPG) are now also performed for gastric cancer. We extended these techniques to treat Siewert type II adenocarcinoma of the esophagogastric junction (AEG). Ten patients with clinical T1 AEG type II underwent laparoscopic transhiatal (LTH) resection combined with LTG reconstructed by Roux-en-Y (LTH+LTG: n=2) or LPG reconstructed by jejunal interposition (LTH+LPG: n=8). Intracorporeal esophagojejunostomy was performed using a circular stapler, of which the anvil head was introduced transabdominally or transorally. The median operation time was 243 minutes, and blood loss was 25.5 g. There were no intraoperative complications or conversion to open surgery. No anastomotic leak was observed, but 1 diaphragmatic herniation to the left thoracic cavity occurred postoperatively. The median length of the proximal margin was 14.5 mm. This operation is technically feasible and can be safely performed after adequate experience of LTG or LPG, though esophagojejunostomy in the mediastinum is technically demanding.
authors.affiliation: Department of Surgical Oncology, National Cancer Center Hospital East, Kashiwa, Japan. takkinos@east.ncc.go.jp
authors.forename: Takahiro
authors.initials: T
authors.lastname: Kinoshita
authors.forename: Naoto
authors.initials: N
authors.lastname: Gotohda
authors.forename: Yuichiro
authors.initials: Y
authors.lastname: Kato
authors.forename: Shinichiro
authors.initials: S
authors.lastname: Takahashi
authors.forename: Masaru
authors.initials: M
authors.lastname: Konishi
authors.forename: Shinichi
authors.initials: S
authors.lastname: Okazumi
authors.forename: Ryoji
authors.initials: R
authors.lastname: Katoh
authors.forename: Taira
authors.initials: T
authors.lastname: Kinoshita
mesh_terms: D000230:Adenocarcinoma / Q000601:surgery*; D000328:Adult; D000368:Aged; D000369:Aged, 80 and over; D000713:Anastomosis, Roux-en-Y / Q000379:methods; D016629:Esophagectomy / Q000379:methods; D004943:Esophagogastric Junction / Q000601:surgery*; D005240:Feasibility Studies; D005260:Female; D005743:Gastrectomy / Q000379:methods; D006801:Humans; D010535:Laparoscopy / Q000379:methods*; D007902:Length of Stay; D008197:Lymph Node Excision / Q000379:methods; D008297:Male; D008875:Middle Aged; D013274:Stomach Neoplasms / Q000601:surgery*