Total esophagogastrectomy plus extended lymphadenectomy with transverse colon interposition:A treatment for extensive esophagogastric junction cancer

AIM:To review the post-operative morbidity and mortality of total esophagogastrectomy(TEG) with second barrier lymphadenectomy(D2) with interposition of a transverse colon and to determine the oncological outcomes of TEG D2 with interposition of a transverse colon.METHODS:This study consisted of a retrospective review of patients with a cancer diagnosis who underwent TEG between 1997 and 2013. Demographic data,surgeryprotocols,complications according to Clavien-Dindo classifications,final pathological reports,oncological follow-ups and causes of death were recorded. We used the TNM 2010 and Japanese classifications for nodal dissection of gastric cancer. We used descriptive statistical analysis and Kaplan-Meier survival curves. A P-value of less than 0.05 was considered statistically significant.RESULTS:The series consisted of 21 patients(80.9% men). The median age was 60 years. The 2 main surgical indications were extensive esophagogastric junction cancers(85.7%) and double cancers(14.2%). The mean total surgery time was 405 min(352-465 min). Interposition of a transverse colon through the posterior mediastinum was used for replacement in all cases. Splenectomy was required in 13 patients(61.9%),distal pancreatectomy was required in 2 patients(9.5%) and resection of the left adrenal gland was required in 1 patient(4.7%). No residual cancer surgery was achieved in 75.1% of patients. A total of 71.4% of patients had a postoperative complication. Respiratory complications were the most frequently observed complication. Postoperative mortality was 5.8%. Median follow-up was 13.4 mo. Surgery specific survival at 5 years of follow-up was 32.8%; for patients with curative surgery,it was 39.5% at 5 years.CONCLUSION:TEG for cancer with interposition of a transverse colon is a very complex surgery,and it presents high post-operative morbidity and adequate oncological outcomes.