Comparison of transabdominal and transthoracic surgical approaches in the treatment of Siewert type II esophagogastric junction cancers: A propensity score-matching analysis
Menée auprès de 397 patients atteints d'un cancer de la jonction oeso-gastrique de type II (classification de Siewert) traité chirurgicalement entre 2001 et 2019 (durée médiane de suivi : 39 mois), cette étude évalue l'intérêt, du point de vue des données intra- et périopératoires (perte de sang, durée de l'opération, durée d'hospitalisation, ...), de deux modalités chirurgicales, l'une par voie transabdominale, l'autre par voie transthoracique
Background: The appropriate surgical approach for Siewert type II esophagogastric junction (EGJ) cancer remains under discussion. We compared surgical outcomes between transabdominal (TA) and transthoracic (TT) approaches for treating type II EGJ cancers. Materials and methods: This retrospective study reviewed 397 type II EGJ cancer patients who underwent surgery from January 2001 to May 2019. We used a 1:3 propensity score-matching method for the analysis. The matching factors were age, sex, American Society of Anesthesiologists score, period of operation, and pathologic stage. Matching was performed using the MatchIt package of R 4.0.2. Results: A total of 46 patients in the TT group was matched to 126 patients in the TA group. R0 resection was achieved in both groups and was statistically different between groups (p = 0.455). In the TA group, the operation time and in-hospital stay length were significantly shorter (p < 0.001) and the intraoperative estimated blood loss (EBL) was significantly lower than in the TT group (p = 0.011). The postoperative complication rate between the two groups was significantly different (p = 0.003). There was marginal difference in the five-year OS rate (p = 0.049) and significant difference in the five-year DFS (p = 0.039). However, surgical approach was not a significant prognostic factor in multivariate analysis of OS or DFS. Conclusions: There was no clear survival benefit of one approach over the other. However, less intraoperative bleeding, lower postoperative complication rate, shorter operation time, and reduced in-hospital stay length were correlated with the TA approach.