Systematic review of quality of life after esophagectomy and total gastrectomy in patients with gastro-esophageal junction cancer

Outcomes After Resection of Adenocarcinoma of the Gastric Cardia by Surgical Approach

BACKGROUND

Total gastrectomy and esophagectomy are commonly used surgical approaches for cardia gastric adenocarcinoma (GA) resection. However, the preferred approach remains unclear. The objectives of this study were to identify predictors of receipt of surgical approach type and compare surgical approach outcomes.

PATIENTS AND METHODS

Patients with stage IB-IIIC cardia GA from 2004 to 2017 were identified within the National Cancer Database. Patients were compared on the basis of receipt of total gastrectomy versus partial gastrectomy with esophagectomy. Predictors of receiving esophagectomy were identified using multivariable logistic regression. Predictors associated with overall survival (OS) were assessed using a multivariable Cox proportional hazards model.

RESULTS

A total of 9841 patients were included. More patients underwent esophagectomy compared with total gastrectomy (77.2% vs. 22.8%). Surgical approach utilization did not vary significantly over time (p = 0.6). Patients who were non-white or female (OR 0.8, 95% CI 0.7-0.9) were less likely to receive esophagectomy. The median number of lymph nodes resected was greater for total gastrectomy versus esophagectomy (18 vs. 15, p < 0.01). There was no difference in resection margins (93.6% vs. 94.5%, p = 0.3) or 30-day mortality (3.0% vs. 2.5%, p = 0.2). Total gastrectomy and esophagectomy had similar OS (40.2 vs. 40.1 months, p = 0.7). On multivariate analysis, there was no difference in survival for total gastrectomy versus esophagectomy (HR 1.0, 95% CI 0.9-1.0).

CONCLUSIONS

Utilization of total gastrectomy and esophagectomy has remained stable over time with esophagectomy being more utilized. These approaches exhibit similar oncologic outcomes for proximal GA. Surgeons should consider long-term outcomes, such as quality of life and nutritional status, when selecting an approach.

Impact of sarcopenic obesity on surgical complications and oncologic outcomes of upper gastrointestinal tumors: a systematic review and meta-analysis

Sarcopenic obesity (SO) is a new entity whose definition encompasses the diagnosis of overweight in malnourished patients. The aim of the review was to assess the impact of body composition in patients with esophago-gastric tumors (EGT) on perioperative and oncological outcomes. This systematic review was conducted under the PRISMA guidelines. MEDLINE (PubMed), Embase, Web of Science and SCOPUS databases were searched until January 2024. Sixteen articles were identified for analysis analyzing 5,378 patients. The prevalence of SO was 10% (95%CI: 6-16; I2 = 94%). Preoperative diagnosis of SO was associated with a twofold increased risk of severe postoperative complications (OR 2.32 [95%CI 1.41-3.82] I2 = 70%). Meta-analysis of overall survival outcomes identified that SO was associated with worse overall survival (HR 2.30; 95%CI 1.46-3.61).

Prognostic significance of subcarinal lymph node involvement in patients with Siewert type I and II gastro-esophageal junctional adenocarcinoma: an analysis of 698 patients undergoing Ivor-Lewis esophagectomy

Gastro-esophageal junction (GOJ) adenocarcinoma is increasingly common and despite significant changes in management over the past decade, overall survival remains poor. Determining factors that influence survival is important for optimizing curative surgery. The prognostic significance of subcarinal lymph node involvement is unclear. The purpose of this study was to assess the prognostic significance of subcarinal lymph node involvement in patients undergoing curative resection of GOJ adenocarcinoma. Consecutive patients undergoing curative 2-stage Ivor-Lewis esophagectomy between February 2010 and January 2022 were analyzed retrospectively from a prospectively maintained database for Siewert type I and II GOJ adenocarcinoma confirmed on histopathology. Outcomes were compared based on subcarinal node involvement confirmed on histopathology. A total of 698 patients with Siewert type I (n = 314) and II (n = 384) adenocarcinoma were analyzed [median age 68 (31-85), 604 males (87%) neo-adjuvant use 491 (74.4%)]. Eighteen patients (2.6%) had subcarinal lymph node involvement. These patients had more advanced overall stage of disease and positive node involvement than those without and a significantly lower median survival of 6 months (<1-25) compared to 53 months (41-65) (p < 0.001). On multivariate analysis, pathological T stage, para-gastric and subcarinal lymph node involvement were found to be the independent and significant factors influencing survival. Subcarinal lymph node involvement is an indicator of advanced disease and high positive node burden. It is an independent prognostic factor in patients undergoing curative surgery for Siewert type I and II GOJ adenocarcinoma.

The Multidisciplinary Approach and Surgical Management of GE Junction Adenocarcinoma

Gastroesophageal (GE) junction adenocarcinoma is an aggressive malignancy of growing incidence and is associated with public health issues such as obesity and GERD. Management has evolved over the last two decades to incorporate a multidisciplinary approach, including endoscopic intervention, neoadjuvant chemotherapy/chemoradiation, and minimally invasive or more limited surgical approaches. Surgical approaches include esophagectomy, total gastrectomy, and, more recently, proximal gastrectomy. This review analyzes the evidence for and applicability of these varied approaches in management, as well as areas of continued controversy and investigation.