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BRIDGING THE GAP AFTER ESOPHAGO GASTRECTOMY FOR LOCALLY ADVANCED TYPE2 GE JUNCTION TUMORS WITH ESOPHAGO GASTROSTOMY OR ESOPHAGO JEJUNOSTOMY AND ANALYSIS OF OUTCOME
Chandramohan Servarayan Murugesan*1,2, Balakumaran Sathyamoorthy1,2, Kanagavel Manickavasagam2, Madhusudhanan Devanathan2
1Madras Medical College, Chennai, India; 2CENTER FOR GASTRO ESOPHAGEAL DISORDERS, ESOINDIA, CHENNAI, TAMILNADU, India
Background and objective
In the management of GE junction tumors type1 and type 3 tumors are managed without any controversy. But the border issue arises in type 2 cancers especially when it is locally advanced. The Surgical options include esophago proximal gastrectomy and esophago gastrostomy, esophago total gastrectomy and esophago jejunostomy depending upon the extent of the tumor. However, the functional result after either of these procedures varies. Aim of the present study is to assess the feasibility and outcome of both types of resection and reconstruction after esophago gastrectomy for locally advanced Type 2 GE junction tumors
Materials and methods:
148 consecutive patients who underwent surgery for GE junction tumors in the last 6 years were evaluated. Of them 62 locally advanced type2 GE junction tumors were included in our study. 26 underwent esophago proximal gastrectomy and with esophago gastrostomy. 36 underwent esophago total gastrectomy with esophago jejunal anastamosis. Intra operative details like Operative time, blood loss, the distal margin, nodal clearance were analyzed. Short term outcome up to one year follow up was analyzed.
Results:
There is no significant difference in operating time, blood loss. Two patients with proximal gastrectomy had positive distal margin even though frozen section was negative. The average number of nodes harvested is higher with total gastrectomy group with jejunal anastamosis and it is statistically significant between 2 groups (p<0.05). Reflux is more with gastric conduit when compared to Jejunal reconstruction. There is no statistically significant difference in weight gain, leak rate, pulmonary complications and dumping symptoms.
Conclusion:
The functional and oncological outcome was superior with jejunal reconstruction after esophago total gastrectomy when compared with gastric reconstruction after esophago proximal gastrectomy in the surgical management of locally advanced type2 GEJ adenocarcinoma.
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