Long-term results of hand-assisted laparoscopic gastrectomy for advanced Siewert type II and type III esophagogastric junction adenocarcinoma

Background: Hand-assisted laparoscopic surgery (HALS) combines laparoscopic surgery with the tactile feedback of a hand-assist device for complex laparoscopic operations. This study aimed to comparatively evaluate the long-term outcomes of patients who underwent HALS versus open surgery for the treatment of advanced Siewert type II and type III adenocarcinoma of the esophagogastric junction (AEG). Methods: A retrospective analysis of 77 patients with advanced Siewert type II and IIIAEG between March 2010 and March 2011. Data concerning the basic characteristics of patients, pathological staging, early postoperative course, and long-term follow-up were collected and analyzed. Results: HALS resulted in significantly lower mean blood loss and mean postoperative hospital stay in comparison to open surgery (P = 0.007 and 0.01, respectively). The mean number of resected lymph nodes was 23.22 +/- 9.36 in the HALS group, which was more than in the open surgery group (18.61 +/- 6.91, P = 0.015). The cumulative 5-year overall survival (OS) rate was 52.8% (95% CI 43.07-60.09) for all patients in the HALS group (78.6% for stage II patients and 36.4% for stage III patients). The 5-year OS rate was not significantly different between both groups. Conclusions: While achieving similar oncological outcomes to open surgery, the HALS approach resulted in reduced blood loss, shortened postoperative hospital stay, and the resection of more lymph nodes. This analysis suggests that HALS may serve as a less invasive and as successful alternative to open surgery for the treatment of advanced Siewert type II and type IIIAEG.