Left thoracoabdominal approach for adenocarcinoma of the esophagogastric junction.

Background/aims: To evaluate usefulness of esophagogastrectomy via left thoracoabdominal (LT) approach for adenocarcinoma of the esophagogastric junction (AEG), the results of surgery stratified by Siewert's classification, were analyzed retrospectively.

Methodology: The tumor diameter, distance of the proximal tumor border from the esophagogastric junction, and length of the esophagus in the resected specimens of consecutive 171 AEG patients were measured. The surgical approach was classified as total esophagectomy (TE), esophagogastrectomy via LT, or transhiatal/abdominal (HA) approach.

Results: Sixteen patients underwent TE, 71 had LT, and 84 had HA. Overall survival of the TE and LT groups was significantly lower than that of the HA group. The difference was seen between LT and HA for type II T3 tumors, but the tumor diameter in LT was significantly larger than that in HA. The approach could not be determined by Siewert's classification, but by distance of proximal tumor border from the junction. The tumors with distance over 5cm might be indicated for the TE approach; 5-3cm, the LT; within 3cm, the HA. The percentage of patients in whom the LT approach is indicated might be only 19%.

Conclusion: Left thoracoabdominal esophagogastrectomy may be valid for some AEG.