© 2016 Wichtg Publishing TJ ISSN 0300-8916 Tumori 2016; 102(4): 352-360 REVIEW When involving the esophagogastric juncton (EGJ), esophageal adenocarcinoma can be divided according to its locaton in Siewert 1, Siewert 2, and Siewert 3 lesions, when the tumor center is located 1 cm to 5 cm above the anatomic EGJ, 1 cm above to 2 cm below the EGJ, or 2 cm to 5 cm be- low the EGJ, respectvely (4). Siewert 3 lesions are considered gastric tumors according to the 2015 Natonal Comprehen- sive Cancer Network (NCCN) guidelines and their treatment should follow the recommendatons for gastric cancer. Squa- mous cell carcinoma and adenocarcinoma of the esophagus difer in terms of risk factors and incidence, but there is some disagreement about the impact of histology on the response to treatment and in partcular neoadjuvant treatments (3). However, given the diferences in prognosis and response to surgical treatment, the NCCN guidelines identfed 2 diferent stage groups and treatment algorithms. Surgery can be defnitve treatment for Tis, T1 and T2 car- cinoma of the esophagus, while the role of preoperatve che- motherapy and radiotherapy for stage II and III disease is stll debated (3). Inadequate trial designs, small sample sizes and variability in the surgical strategies are the reasons why up to now most randomized trials comparing surgery alone versus preoperatve chemoradiotherapy have been critcized (5). In a large study published in 2012, van Hagen and colleagues (6) showed beter overall survival (OS) and disease-free survival DOI: 10.5301/tj.5000517 Transthoracically or transabdominally: how to approach adenocarcinoma of the distal esophagus and cardia. A meta-analysis Paolo Aurello, Paolo Magistri, Giammauro Berardi, Niccolò Petrucciani, Dario Sirimarco, Laura Antolino, Giuseppe Nigri, Francesco D’Angelo, Giovanni Ramacciato Department of Medical and Surgical Sciences and Translatonal Medicine, Faculty of Medicine and Psychology, Sapienza University, Rome - Italy Introducton Esophageal carcinoma is the eighth most frequent cancer worldwide and the sixth cancer-related cause of death (1). According to the World Health Organizaton (WHO) around 80% of the cases occur in less developed countries, with a mortality- to-incidence rato of 0.88. In recent years adenocarcinoma has become the leading subtype of esophageal carcinoma in West- ern countries, replacing squamous cell carcinoma, which now accounts for almost 30% of esophageal cancers (1, 2). Adeno- carcinoma frequently occurs in the distal third of the esopha- gus and is associated with gastroesophageal refux disease, obesity, medicatons that diminish the basal lower esophageal sphincter tone, long-standing tobacco abuse, and previous tho- racic radiaton (1, 3). ABSTRAcT Esophageal carcinoma is the eighth most frequent cancer worldwide and the sixth cancer-related cause of death. Here we propose a new meta-analysis to identfy the most appropriate approach for resectable adenocarcinoma of the distal esophagus and cardia (Siewert 1-2). A systematc literature search was performed independently by 2 of the manuscript’s authors using PubMed, EMBASE, Scopus and the Cochrane Library Central. The follow- ing criteria were set for inclusion in this meta-analysis: 1) studies comparing transthoracic esophagectomy and transhiatal esophagectomy for adenocarcinoma of the esophagus; 2) studies reportng at least 1 perioperatve outcome; and 3) if more than 1 study was reported by the same insttute, only the most recent or the highest quality study was included. A total of 6 artcles dated between 1996 and 2012 fulflled the selecton criteria and were therefore included in this meta-analysis; this pool of artcles consisted of 2 prospectve and 4 retrospectve studies. A statstcally signifcant diference favoring the transthoracic procedure was noted regarding the number of retrieved lymph nodes, 5-year disease-free survival rate and 5-year overall survival rate (p = 0.001, p = 0.05 and p = 0.03, respectvely). In conclusion, transthoracic esophagectomy for adenocarcinoma of the distal esophagus and esophagogastric juncton (Siewert 1-2) appears to be superior to the transhiatal approach in terms of onco- logical outcomes. Keywords: Adenocarcinoma, Esophagectomy, Esophagogastric juncton, Siewert, Transthoracic, Transhiatal Accepted: April 5, 2016 Published online: May 20, 2016 corresponding author: Prof. Paolo Aurello Via di Grotarossa 1035 00189 Rome, Italy paolo.aurello@uniroma1.it