Technical aspects and results of the transhiatal resection in adenocarcinomas of the gastroesophageal junction

The distribution of lymph node metastases of adenocarcinomas of the gastroe sophageal junction is classified into three types. The RO resection with co mplete lymphadenectomy therefore requires different resection methods for t ype 1 and type 2/3 tumors. Comparing the subtotal esophagectomy and the ext ended gastrectomy, no advantage in survival can be seen for one method or o ne tumor type (type 1 or type 2/3). The same is true for the lethality. Ind eed, the transhiatal resection is accompanied by a higher complication rate . However, the different operation methods for cardiacarcinomas, with subto tal esophagectomy in type 1 and extended gastrectomy in type 2/3 tumors, sh ould be maintained because of increased rates of local recurrence that may be expected if all cardiacarcinoma types were treated using subtotal esopha gectomy with gastric tube interposition. Therefore, we suggest a subtotal e sophagectomy only in type 1 tumors. In type 2/3 tumors. an extended gastrec tomy with resection of the distal esophagus, lymphadenectomy of the lower m ediastinum, and D2 lymphadenectomy should be performed.