Outcomes After Laparoscopic Transhiatal Esophagectomy for Siewert Type I Esophagogastric Junction Adenocarcinoma: A Retrospective Cohort Study Publisher Pubmed



Sadreniac S ; Mohammadpour H ; Yavari A ; Nasirnia S ; Mohebbi M ; Karimi A ; Nasab SS ; Bagheri AA ; Mahmoudabadi FD ; Nodoushan SMHT ; Kalajahi AE ; Shadravan MM ; Ghorbani H
Source: Journal of Cardiothoracic Surgery Published:2026

Abstract

Background: Siewert type I esophagogastric junction (EGJ) adenocarcinoma remains surgically challenging, and the role of transhiatal esophagectomy (THE) is debated, particularly in high-incidence and resource-variable settings. Methods: This two-center retrospective cohort study included 101 adults with Siewert type I EGJ adenocarcinoma who underwent laparoscopic THE (January 2020–December 2022). Perioperative morbidity (Clavien–Dindo), 90-day mortality, and stage-stratified overall survival (OS) and disease-free survival (DFS) were assessed; neoadjuvant treatment varied in routine practice. OS/DFS were estimated using Kaplan–Meier methods and compared by log-rank tests. Prespecified time-point endpoints (OS status at 36 months; DFS status at 18 months) were modeled using multivariable logistic regression. Results: Mean age was 63.4 ± 8.9 years and 64.4% were male. Overall 90-day morbidity occurred in 47.5% and 90-day mortality was 7.9%. Pneumonia/aspiration occurred in 14.9%, delayed gastric emptying in 23.8%, and cervical anastomotic leak in 3.9% (managed non-operatively). R0 resection was achieved in 95.0% with a median lymph node yield of 11. Stage-stratified survival differed significantly (log-rank p < 0.001); three-year OS for pathologic stage III was 30%. At 18 months, DFS was 70% for stage 0–I and 54% for stage II–III. Advanced pathologic stage (II–III vs. 0–I) was independently associated with worse OS status at 36 months (OR 3.94; p < 0.001) and DFS status at 18 months (OR 3.39; p < 0.001). Conclusions: In this single-arm cohort, laparoscopic THE was associated with perioperative outcomes and stage-dependent survival estimates. In the absence of a comparative transthoracic cohort, findings should be interpreted descriptively and support prospective comparative studies incorporating long-term and patient-centered outcomes. © The Author(s) 2026.