Total laparoscopic transabdominal-transdiaphragmatic approach for treating Siewert II tumors

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Abstract Background: Although the morbidity of gastric cancer has decreased, the incidence of adenocarcinoma of the esophagogastric junction (AEG) is increasing. Furthermore, no consensus exists on which surgical approach should be applied for Siewert type II AEG. The purpose of our study was to evaluate the technical safety and feasibility of a new surgical approach. Methods: Sixty patients with Siewert type II AEG underwent laparoscopic total gastrectomy with the total laparoscopic transabdominal-transdiaphragmatic (TLTT) approach, which needs an incision in the diaphragm. Results: The median operative time, reconstruction time and estimated blood loss were 214.8±41.60 mins, 29.40±7.09 mins and 209.00±110.27 ml, respectively. All of the patients had negative surgical margins. Conclusion: There were no intraoperative complications or conversions to open surgery. Our surgical procedure provides a unique option for the safe application of laparoscopic lower mediastinal lymph node dissection and gastrointestinal reconstruction. Trial Registration: Chinese Clinical Trial Registry, ChiCTR1800014336. Registered 31 December 2017- Prospectively registered, http://www.chictr.org.cn/edit.aspx?pid=23111&htm=4.

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