P1.228. Adenocarcinoma of the Esophagogastric Junction AEG Type II According to Siewert: Have We Finally Found an Optimal Surgical Strategy?

Abstract

Abstract Topic Esophageal Cancer: Surgical Treatment of Esophageal Cancer – long term outcomes Background The question of the optimal surgical method for cardia carcinoma (AEG II) has been vividly debated for decades. According to guidelines, in AEG II an esophageal resection (IL) or a transhiatal extended gastrectomy (TEG) can be performed. Inspired by Asian reports, since 2019 we have gained experience with proximal gastrectomy with double tract reconstruction (PG-DTR). Methods We present a retrospective analysis of perioperative data and survival data of patients who underwent surgery for a curatively resectable AEG II between 2014 and 2024. The results of the surgical methods are compared with regard to oncological quality criteria, perioperative data, and survival. Results A total of 106 patients (33 women, 73 men) with AEG II were operated on, of whom 37, 31, and 38 underwent IL, TEG, and PG-DTR, respectively, with an R-0 rate of 89.2%, 93.5%, and 94.7%. 8.1%, 16.1%, and 36.8% received no perioperative therapy, whereas 86.5%, 80.6%, and 63.2% received perioperative therapy. The median number of examined lymph nodes was 43.2, 32.9, and 31.3, the median length of hospital stay was 11, 12, and 12 days, the rate of severe perioperative complications was 16.2%, 29%, and 38.9% (p=0.09), hospital mortality was 2.7%, 0%, and 0% (overall 0.9%), and anastomotic leaks were observed in 2.7%, 19.4%, and 15.8%. Tumor recurrences or metastases occurred in 24.3%, 41.9%, and 26.3%, respectively, with the most frequent localization occurring in the peritoneum. The cumulative 1- and 3-year survival rates (IL, TEG and PG-DTR) were 94%, 93%, and 97% and 78%, 62%, and 70%, respectively. Conclusion In both groups with supradiaphragmatic esophagojejunostomy, the leak rate was significantly higher than in in the group with thoracic esophagogastrostomy. Although PG-DTR represents a limited procedure compared with IL and TEG, the degree of fulfillment of oncological quality parameters was adequate in all three surgical methods. With regard to both perioperative safety and survival data, PG-DTR appears to be an equivalent alternative. In our experience, patient acceptance of PG-DTR is noticeably higher than of the standard methods.