Systematic review of the surgical strategies of adenocarcinomas of the gastroesophageal junction

•We performed a systematic review of the surgical strategies for GEJ tumors.•Neither esophagectomy nor gastrectomy offered an apparent 5-year survival benefit.•R0 resection rates and lymph node yields did not significantly differ.•Mortality and morbidity rates were also comparable for both techniques.•Long-term QoL was more severely affected after esophagectomy than gastrectomy.

IntroductionThe optimal surgical treatment of patients with adenocarcinoma of the gastroesophageal junction has not been established yet.ObjectiveTo evaluate the surgical strategies to treat adenocarcinoma of the gastroesophageal junction.MethodsDatabases Pubmed, Cochrane, and Embase were searched for “adenocarcinoma of the gastroesophageal junction” AND (“surgery” OR “esophagectomy” OR “gastrectomy”) or its synonyms or abbreviations. Only comparative studies that evaluated gastrectomy versus esophagectomy were included.ResultsIn total 10 cohort studies comparing esophagectomy versus gastrectomy fulfilled the quality criteria. The R0 resection rates varied between 72–93% for esophagectomy and 62%–93% for gastrectomy. Morbidity was 33–39% after esophagectomy versus 11–54% after gastrectomy. The 30-day mortality ranged between 1.0–2.3 after esophagectomy and 1.8–2.7% after gastrectomy. At 6 months after surgery, health-related quality of life was higher after total gastrectomy than after esophagectomy. The 5-year survival rates varied between 30–42% for esophagectomy and 18–38% for gastrectomy, but were not significantly different.ConclusionNo clear oncologic benefit of either esophagectomy or gastrectomy in patients with adenomacarcinoma of gastroesophageal junction could be observed. However, gastrectomy seems to be accompanied with better quality of life. Future research should preferably consist of a multicenter RCT comparing esophagectomy and gastrectomy for adenocarcinomas of the gastroesophageal junction.