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Background <p>The optimal surgical approach for Siewert type II adenocarcinoma of the esophagogastric junction (AEG) remains controversial because of the complex lymphatic spread and anatomical constraints. We previously developed a novel minimally invasive abdominal and left thoracic approach (MALTA) to overcome the limitations of conventional techniques. This study aimed to provide an updated analysis of MALTA with extended follow-up period compared with our initial report.</p> Method <p>A retrospective review was conducted on 16 consecutive patients who underwent MALTA for Siewert type II AEG between 2013 and 2023. The procedure combined laparoscopic gastrectomy and thoracoscopic lower mediastinal esophagectomy with intrathoracic reconstruction, both of which were performed without intraoperative repositioning. Perioperative outcomes, postoperative complications, and survival rates were analyzed. The Kaplan–Meier method was used to estimate overall survival (OS) and disease-free survival (DFS). The primary outcome was feasibility and safety (R0 resection rate and postoperative complications). Secondary outcomes included OS and DFS.</p> Results <p>R0 resection was achieved in all patients. The median operative time was 438&#xa0;min, and median blood loss was 28&#xa0;mL. Postoperative complications occurred in 31.3% of the patients, including anastomotic leakage (12.5%) and empyema (18.8%). No in-hospital deaths or respiratory complications were reported. The median follow-up duration was 51&#xa0;months. The 1-, 3-, and 5-year OS rates were 87.5% (95% confidence interval [CI], 61.4–96.9), 67.7% (95% CI, 41.8–85.9), and 60.2% (95% CI, 34.7–81.1), respectively. The DFS rates were 68.8% (95% CI, 43.3–86.4), 56.3% (95% CI, 32.4–77.5), and 42.9% (95% CI, 21.5–67.3), respectively.</p> Conclusions <p>MALTA appears to be a feasible, safe, and minimally invasive option for Siewert type II AEG, enabling stable intrathoracic anastomosis without patient repositioning. These results suggest its potential utility in achieving favorable perioperative and survival outcomes.</p> Graphical Abstract <p></p>

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Minimally invasive abdominal and left thoracic approach (MALTA) for Siewert type II esophagogastric junction adenocarcinoma: A retrospective cohort study of perioperative and oncologic outcomes

  • 期刊论文

  • 发表日期：

    2025年10月29日

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  • Takeo Nitta,
  • Yuma Ebihara,
  • Ryo Takagi,
  • Hironobu Takano,
  • Saseem Poudel,
  • Hideyuki Wada,
  • Toshiaki Shichinohe,
  • Satoshi Hirano

摘要

Background

The optimal surgical approach for Siewert type II adenocarcinoma of the esophagogastric junction (AEG) remains controversial because of the complex lymphatic spread and anatomical constraints. We previously developed a novel minimally invasive abdominal and left thoracic approach (MALTA) to overcome the limitations of conventional techniques. This study aimed to provide an updated analysis of MALTA with extended follow-up period compared with our initial report.

Method

A retrospective review was conducted on 16 consecutive patients who underwent MALTA for Siewert type II AEG between 2013 and 2023. The procedure combined laparoscopic gastrectomy and thoracoscopic lower mediastinal esophagectomy with intrathoracic reconstruction, both of which were performed without intraoperative repositioning. Perioperative outcomes, postoperative complications, and survival rates were analyzed. The Kaplan–Meier method was used to estimate overall survival (OS) and disease-free survival (DFS). The primary outcome was feasibility and safety (R0 resection rate and postoperative complications). Secondary outcomes included OS and DFS.

Results

R0 resection was achieved in all patients. The median operative time was 438 min, and median blood loss was 28 mL. Postoperative complications occurred in 31.3% of the patients, including anastomotic leakage (12.5%) and empyema (18.8%). No in-hospital deaths or respiratory complications were reported. The median follow-up duration was 51 months. The 1-, 3-, and 5-year OS rates were 87.5% (95% confidence interval [CI], 61.4–96.9), 67.7% (95% CI, 41.8–85.9), and 60.2% (95% CI, 34.7–81.1), respectively. The DFS rates were 68.8% (95% CI, 43.3–86.4), 56.3% (95% CI, 32.4–77.5), and 42.9% (95% CI, 21.5–67.3), respectively.

Conclusions

MALTA appears to be a feasible, safe, and minimally invasive option for Siewert type II AEG, enabling stable intrathoracic anastomosis without patient repositioning. These results suggest its potential utility in achieving favorable perioperative and survival outcomes.

Graphical Abstract