Background: The treatment algorithm for the esophagogastric junction (EGJ) carcinoma was jointly stated by Japan Gastric Cancer Association and Japan Esophagus Society in 2014. It shows the optimal extent of lymph node (LN) dissection for EGJ carcinoma. For the tumor of the true cardia， upper perigastric， suprapancreatic and lower mediastinal LN dissection is recommended. Surgery of these deep fields is the strongest point of laparoscopic surgery. In this paper， I explain our strategy and procedure for the treatment of EGJ carcinoma， focusing on the mediastinal LN dissection.

 

Surgical procedure: Laparoscopic proximal gastrectomy with transhiatal lower esophagectomy is selected for EGJ carcinoma located in the true cardiac region.  Perigastric， suprapancreatic and lower mediastinal LN dissection is done laparoscopically. For the tumor with esophageal invasion of 3cm or more， middle mediastinal LN dissection is added via right transthoracic/thoracoscopic approach. Reconstruction was performed by esophagogastric tube reconstruction or double-tract method.

 

Results: From April 2011， we performed laparoscopic proximal gastrectomy with transhiatal or transthoracic/thoracoscopic esophagectomy in 33 patients with EGJ carcinoma. Tumor stage was determined as IA， IB， IIA， IIB， IIIA， IIIB， IIIC and IV in 7， 5， 6， 3， 3， 2， 2 and 4 patients， respectively. Median operation time was 313 min.， and number of retrieved mediastinal LNs was 3. Complication which is Clavian-Dindo grade III or more was 2 of anastomotic leakage and 2 of pulmonary disease. The 3-year overall survival rate and relapse free survival rate were 55.2% and 67.9%， respectively.

 

Conclusion: Although long-term results are needed， laparoscopic surgery is safe and adequate as the treatment of EGJ carcinoma.