• Luca Maria Siani, Fabrizio Ferranti, Marco Marzano, Marco Benedetti, and Alberto Quintiliani.
• U.O.C. Chirurgia Generale e Miniinvasiva, Ospedale S. Paolo, Civitavecchia (ASL-RM/F), Roma.
• Chir Ital. 2009 May 1; 61 (3): 289-94.

AbstractAdenocarcinoma of the gastro-oesophageal junction is progressively rising in western countries and, because of its poor prognosis, presents a real clinical challenge for the oncological surgeon. We evaluate our initial experience with wholly laparoscopic trans-hiatal extended total gastrectomy with the Or-Vil device for treating Siewert type II and III tumours of the gastro-oesophageal junction. Ten patients were enrolled in the present study; ASA score, stage of disease, length of surgery, estimated blood loss, number of lymph nodes harvested, length of proximal margin clearance, morbidity and mortality were analysed. Mortality was nil and morbidity 20%; the average proximal clearance margin was 5.7 cm and all margins were tumour-free (RO). The number of lymph nodes harvested was 38 +/- 19. Neither anastomotic fistulas nor major dehiscence were observed. In our initial experience, wholly laparoscopic trans-hiatal extended total gastrectomy for treating Siewert type II and III tumours of the gastro-oesophageal junction is safe, effective and, according to our preliminary results, oncologically correct, but it remains a complex, advanced laparoscopic procedure, requiring major skills and adequate experience. Prospective, randomised trials--possibly multicentric--are required to establish its efficacy in terms of long-term oncological outcomes.

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