Outcomes of transmediastinal esophagectomy for patients with esophagogastric junction cancers

PURPOSE: We aimed to evaluate the outcomes of transmediastinal esophagectomy (TME) for esophagogastric junction cancer (EGJC) patients. METHODS: We retrospectively reviewed patients who underwent TME for EGJC (Siewert Type II) between 2018 and 2023. Robot-assisted TME was performed using a robotic surgical system (DaVinci). Postoperative complications, overall survival (OS) and disease-free survival (DFS) were investigated. RESULTS: The median length of esophageal invasion was 3 cm. Adenocarcinoma was the most common tumor in our series (71.1%). A robotic approach was used for 25 (65.8%) patients. The most frequent major complication was pneumonia (≥ Grade I, n = 12, 31.6%), followed by recurrent laryngeal nerve palsy (≥ Grade I, n = 6, 15.8%). The incidence of anastomotic leakage (≥ Grade II) was 5.3% (n = 2). The 30-day mortality rate was 0%. The 3-year OS and DFS rates were 67.5 and 51.8%, respectively. The distribution of pathological LN metastases did not significantly demarcate OS curves (P = 0.43), while significantly stratifying DFS curves (P < 0.001). Patients with both mediastinal and abdominal LN metastases had very poor DFS (2-year DFS; 0%). CONCLUSIONS: TME for EGJC can be performed safely without increasing complications such as severe anastomotic leakage and in-hospital death. The relatively high frequency of pneumonia should be considered.