While gastroesophageal junction tumors share some characteristics with both stomach and esophageal cancers, they also exhibit distinct aspects of each. In recent years, these tumors have been regarded as a separate entity. The optimal surgical approach for Siewert type 2 adenocarcinomas is still a subject of debate. This research evaluates the early clinical outcomes and long-term survival associated with transabdominal and transthoracic surgical approaches in patients with Siewert type 2 adenocarcinoma.

This retrospective study analyzes data from patients who underwent surgery for gastroesophageal junction adenocarcinoma from January 2014 to December 2022. Patients diagnosed with Siewert type 2 adenocarcinoma through pathological examination were classified into three categories: Ivor Lewis, total gastrectomy, and proximal gastrectomy. The groups were analyzed for early postoperative morbidity and long-term survival outcomes.

The study included 104 patients diagnosed with Siewert type 2 adenocarcinoma. The Ivor Lewis procedure was performed on 27 patients, total gastrectomy on 41 patients, and proximal gastrectomy on 36 patients. The analysis of postoperative complications revealed that transthoracic procedures were markedly associated with the increased occurrence of pulmonary complications. The five-year overall survival rates were 53% (CI: 33.7%–83.4%) for the Ivor Lewis group, 49.3% (CI: 33.9%–71.9%) for the total gastrectomy group, and 60.2% (CI: 43.1%–83.9%) for the proximal gastrectomy group, with no statistically significant differences observed.

Transabdominal surgical approaches demonstrated a lower incidence of postoperative complications in comparison to transthoracic methods. No significant differences in long-term survival outcomes were observed among the three surgical groups.