Hirokazu Noshiro,Yukie Yoda,Hironori Iwasaki,Taketo Matsunaga,Akihiko Uchiyama,
Requiring Multi-Steps During Minimally Invasive Surgery to Achieve Optimal Proximal Resection Margin for Siewert-Types II and III Esophagogastric Junctional Cancer
Annals of Clinical Oncology
2019
2674-3248
http://dx.doi.org/10.31487/j.ACO.2019.04.02
https://www.sciencerepository.org/requiring-multi-steps-during-minimally-invasive-surgery_ACO-2019-4-102 
Abstract: Background: Transection of the esophagus at a cancer-negative proximal surgical margin and alimentary
tract reconstruction through the hiatus during minimally invasive surgery (MIS) may be complicated and
difficult in some patients with Siewert type II or III esophagogastric junctional cancer (EGJC). In this study,
we retrospectively determined requiring multi-steps during MIS for Siewert types II and III EGJC.
Study Design: Fifty-one consecutive patients with surgically treated Siewert type II or III EGJC were
reviewed from July 2006 to October 2016. Five patients were excluded, and the remaining forty-six patients
were divided into four groups based on the combination of laparoscopic and thoracoscopic surgical
procedures performed, according to Siewert classification and TNM-staging: one-step surgery (n = 16), twostep surgery without novel transection of the esophagus (n = 8), two-step surgery with novel transection of
the esophagus (n = 13), and three-step surgery (n = 9).
Results: The esophagus was transected successfully with a cancer-free proximal margin in all but one
patient. However, only 16 patients (35 %) were treated successfully by laparoscopic surgery alone, and the
remaining 30 patients needed one or more additional steps to complete the anastomosis after transection of
the esophagus according to the extent of esophageal invasion of the tumor.
Conclusion: Multi-step procedures may be needed to achieve a cancer-negative proximal margin followed
by alimentary reconstruction during MIS in patients with Siewert type II or III EGJC. Keywords: Esophagogastric junctional cancer, siewert classification, minimally invasive surgery