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 3cm. 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.