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Background <p>Siewert type I esophagogastric junction (EGJ) adenocarcinoma remains surgically challenging, and the role of transhiatal esophagectomy (THE) is debated, particularly in high-incidence and resource-variable settings.</p> Methods <p>This two-center retrospective cohort study included 101 adults with Siewert type I EGJ adenocarcinoma who underwent laparoscopic THE (January 2020–December 2022). Perioperative morbidity (Clavien–Dindo), 90-day mortality, and stage-stratified overall survival (OS) and disease-free survival (DFS) were assessed; neoadjuvant treatment varied in routine practice. OS/DFS were estimated using Kaplan–Meier methods and compared by log-rank tests. Prespecified time-point endpoints (OS status at 36 months; DFS status at 18 months) were modeled using multivariable logistic regression.</p> Results <p>Mean age was 63.4 ± 8.9 years and 64.4% were male. Overall 90-day morbidity occurred in 47.5% and 90-day mortality was 7.9%. Pneumonia/aspiration occurred in 14.9%, delayed gastric emptying in 23.8%, and cervical anastomotic leak in 3.9% (managed non-operatively). R0 resection was achieved in 95.0% with a median lymph node yield of 11. Stage-stratified survival differed significantly (log-rank <i>p</i> &lt; 0.001); three-year OS for pathologic stage III was 30%. At 18 months, DFS was 70% for stage 0–I and 54% for stage II–III. Advanced pathologic stage (II–III vs. 0–I) was independently associated with worse OS status at 36 months (OR 3.94; <i>p</i> &lt; 0.001) and DFS status at 18 months (OR 3.39; <i>p</i> &lt; 0.001).</p> Conclusions <p>In this single-arm cohort, laparoscopic THE was associated with perioperative outcomes and stage-dependent survival estimates. In the absence of a comparative transthoracic cohort, findings should be interpreted descriptively and support prospective comparative studies incorporating long-term and patient-centered outcomes.</p>

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Outcomes after laparoscopic transhiatal esophagectomy for siewert type I esophagogastric junction adenocarcinoma: a retrospective cohort study

  • 期刊论文

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  • 发表日期：

    2026年4月8日

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  • Saeed Sadreniac,
  • Hassan Mohammadpour,
  • Ali Yavari,
  • Shima Nasirnia,
  • Mahdi Mohebbi,
  • Amirhossein Karimi,
  • Sina Salimi Nasab,
  • Amir Abbas Bagheri,
  • Farzad Dehghani Mahmoudabadi,
  • Seyed Mohamad Hossein Tabatabaei Nodoushan,
  • Amin Esfandiari Kalajahi,
  • Mohammad Mehdi Shadravan,
  • Helia Ghorbani

摘要

Background

Siewert type I esophagogastric junction (EGJ) adenocarcinoma remains surgically challenging, and the role of transhiatal esophagectomy (THE) is debated, particularly in high-incidence and resource-variable settings.

Methods

This two-center retrospective cohort study included 101 adults with Siewert type I EGJ adenocarcinoma who underwent laparoscopic THE (January 2020–December 2022). Perioperative morbidity (Clavien–Dindo), 90-day mortality, and stage-stratified overall survival (OS) and disease-free survival (DFS) were assessed; neoadjuvant treatment varied in routine practice. OS/DFS were estimated using Kaplan–Meier methods and compared by log-rank tests. Prespecified time-point endpoints (OS status at 36 months; DFS status at 18 months) were modeled using multivariable logistic regression.

Results

Mean age was 63.4 ± 8.9 years and 64.4% were male. Overall 90-day morbidity occurred in 47.5% and 90-day mortality was 7.9%. Pneumonia/aspiration occurred in 14.9%, delayed gastric emptying in 23.8%, and cervical anastomotic leak in 3.9% (managed non-operatively). R0 resection was achieved in 95.0% with a median lymph node yield of 11. Stage-stratified survival differed significantly (log-rank p < 0.001); three-year OS for pathologic stage III was 30%. At 18 months, DFS was 70% for stage 0–I and 54% for stage II–III. Advanced pathologic stage (II–III vs. 0–I) was independently associated with worse OS status at 36 months (OR 3.94; p < 0.001) and DFS status at 18 months (OR 3.39; p < 0.001).

Conclusions

In this single-arm cohort, laparoscopic THE was associated with perioperative outcomes and stage-dependent survival estimates. In the absence of a comparative transthoracic cohort, findings should be interpreted descriptively and support prospective comparative studies incorporating long-term and patient-centered outcomes.