Combined total gastrectomy, total esophagectomy, and D2 lymph node dissection with transverse colonic interposition for adenocarcinoma of the gastroesophageal junction

The surgical treatment of adenocarcinoma of the gastroesophageal junction (GEJ) is complex. A large tumor involving a substantial portion of both the esophagus and stomach requires complete resection with negative proximal and distal margins as well as D2 lymph node dissection. Some investigators have found that patients who do not undergo radical resection have a worse prognosis; however, more aggressive surgical treatments are associated with increased morbidity and mortality. We describe our operative technique designed for complete resection of tumors of the GEJ. We used this technique to operate on nine patients, none of whom suffered anastomotic leakage or necrosis of the colonic interposition graft.