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Shibao et al. Mini-invasive Surg 2019;3:16 Mini-invasive Surgery
DOI: 10.20517/2574-1225.2019.01

Review Open Access

Minimally invasive approach for cancer of the
esophagogastric junction

Kazunori Shibao, Masahiro Mitsuyoshi, Nobutaka Matayoshi, Yuzuru Inoue, Takefumi Katsuki, Nagahiro
Sato, Keiji Hirata

Department of Surgery I, School of Medicine, University of Occupational and Environmental Health Japan, 1-1 Iseigaoka,
Yahatanishi-ward, Kitakyushun 807-8555, Japan.

Correspondence to: Dr. Kazunori Shibao, Department of Surgery I, School of Medicine, University of Occupational and
Environmental Health Japan 1-1 Iseigaoka, Yahatanishi-ward, Kitakyushu 807-8555, Japan. E-mail: shibao@med.uoeh-u.ac.jp
How to cite this article: Shibao K, Mitsuyoshi M, Matayoshi N, Inoue Y, Katsuki T, Sato N, Hirata K. Minimally invasive approach
for cancer of the esophagogastric junction. Mini-invasive Surg 2019;3:16. http://dx.doi.org/10.20517/2574-1225.2019.01
Received: 11 Jan 2019 First Decision: 26 Apr 2019 Revised: 10 May 2019 Accepted: 28 May 2019 Published: 18 Jun 2019

Science Editor: Tetsu Fukunaga Copy Editor: Cai-Hong Wang Production Editor: Jing Yu

Abstract
The incidence of esophagogastric junction (EGJ) cancer is increasing in the world. EGJ cancer is traditionally classified
by the Siewert classification, despite its limitations. The definition and classification of EGJ cancer is a controversial
topic. Thus, the best available strategy for the surgical treatment of EGJ cancer remains controversial. This chapter
reviews a minimally invasive approaches for EGJ cancer. Most operations for EGJ cancer that are performed by
open surgery can be performed minimally invasively. A minimally invasive transthoracic approach (Ivor-Lewis or
McKeown esophagectomy) is the optimal surgical approach for Siewert type I cancer. Mediastinoscope-assisted
transhiatal esophagectomy, which was recently reported, may be a suitable surgical option, especially for frail
patients with Siewert type I cancer. Generally, laparoscopic total or proximal gastrectomy is regarded as the standard
for surgerical method for Siewert type III cancer, while both laparoscopic gastrectomy (with lower esophagectomy)
or a minimally invasive Ivor-Lewis approach are recommended for Siewert type II cancer. Minimally invasive
surgery (MIS) has the potential to shorten the length of hospitalization, reduce the risk of postoperative pulmonary
complications, and improve quality of life with a similar margin status, nodal harvest, and survival rate to open
techniques. However, as the existing literature is still limited, the choice of surgical method should be judged by the
experienced surgeons, especially in MIS. This review reveals that further large clinical stuidies are need to deepen
our understanding of MIS for EGJ cancer.

Keywords: Esophagogastric junction cancer, thoraco-abdominal approach, transhiatal approach, minimally invasive
esophagectomy

© The Author(s) 2019. Open Access This article is licensed under a Creative Commons Attribution 4.0
International License (https://creativecommons.org/licenses/by/4.0/), which permits unrestricted use,
sharing, adaptation, distribution and reproduction in any medium or format, for any purpose, even commercially, as long
as you give appropriate credit to the original author(s) and the source, provide a link to the Creative Commons license,
and indicate if changes were made.

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