A Retrospective Study on the Usefulness of Thoracoscopic Laparoscopic Approach Surgery for Esophagogastric Junction Cancer

Abstract Background The optimal extent of lymph node dissection for esophagogastric junction carcinoma has been established from the results of multicenter clinical studies, but the optimal surgical technique and the significance of preoperative therapy remain to be determined. In this congress, we would like to discuss and validate the optimal surgical approach, including postoperative quality of life, based on a retrospective analysis of our own cases of esophagogastric junction cancer. Methods We reviewed 121 cases of esophagogastric junction cancer surgery in our hospital from 2010 to 2019. Multivariate analysis showed that esophageal invasion length (EI) ≥ 21 mm was a risk factor for lower mediastinal lymph node metastasis (OR: 11.8, p = 0.005), and EI ≥ 31 mm was a risk factor for upper mediastinal lymph node metastasis (OR: 13.5, p = 0.026). Based on this results, surgical procedure is selected based on the length of esophageal invasion. For relatively early-stage cancer with low risk of upper and middle mediastinal metastasis, the combined thoracoscopic and laparoscopic approach (cTLA) with lower mediastinal dissection is the basic procedure. Results In cTLA, the esophagogastric anastomosis is performed in the mediastinum. For prevention of gastroesophageal reflux, we perform double flap technique. Twenty-five patients underwent cTLA between 2015 and 2024. The pH impedance monitoring and endoscopy retrospective analysis were performed before and after surgery. Acid reflux evaluation using Demeestar Score showed no postoperative deterioration (p = 0.775), postoperative endoscopic diagnosis of reflux esophagitis was Grade B or higher in only 4 cases, and postoperative PPI maintenance medication in only 4 cases. There were 2 cases of reconstructive complications, but none in the last 4 years. There was only one case of recurrent primary death. Conclusion The indication for esophagogastric junction cancer should be determined by the length of esophageal invasion. cTLA can achieve both radical cure and maintenance of quality of life.