ABSTRACT
Objective:
To investigate the
clinical efficacy of proximal
gastrectomy and total
gastrectomy in the
treatment of Siewert type Ⅱ and Ⅲ
adenocarcinoma of
esophagogastric junction (AEG).
Methods:
The retrospective
cohort study was conducted. The clinicopathological data of 170
patients with Siewert type Ⅱ and Ⅲ AEG
who were admitted to Guangdong Provincial People′s
Hospital from January 2010 to December 2018 were collected. There were 125
males and 45
females,
aged from 30 to 85 years, with a median age of 64 years. Of the 170
patients, 82 cases undergoing proximal
gastrectomy were allocated into the proximal
gastrectomy group and 88 cases undergoing total
gastrectomy were allocated into the total
gastrectomy group.
Observation indica-tors (1) surgical and postoperative situations; (2) follow-up and
survival; (3)
analysis of
prognostic factors. Follow-up was conducted using
telephone interview and
outpatient examination to detect
survival of
patients up to December 2021. Measurement data with
normal distribution were represented as Mean± SD, and comparison between groups was analyzed using the t test.
Measure-ment data with skewed distribution were represented as M( Q1, Q3) or M(range), and comparison between groups was analyzed using the
Mann-Whitney U test. Count data were described as absolute numbers or percentages, and comparison between groups was analyzed using the
chi-square test or Fisher exact
probability. Comparison of ordinal data was analyzed using the rank sum test. Kaplan-Meier
method was used to draw
survival curves, and Log-Rank test was used for
survival analysis. COX
proportional hazard model was used for univariate and
multivariate analyses. Variables with P<0.1 in univariate
analysis were included for
multivariate analysis.
Results:
(1) Surgical and postoperative situations. Cases with surgical approach as transthoracic or thoraco-abdominal approach, transabdominal approach, the operation
time, cases with volume of intra-operative
blood loss ≤100 mL or >100 mL, cases with length of proximal margin ≤1.5 cm or >1.5 cm, cases with radical
surgery outcome as R 0, R 1, R 2, the number of
lymph nodes harvest, cases with
anastomotic leakage, cases with anastomotic
stricture, cases with incision
infection, cases with pleural
infection or effusion, cases with abdominal
infection or
ascites were 61, 21, (211±18)minutes, 46, 36, 44, 38, 73, 6, 3, 15(9,22), 5, 2, 2, 4, 2 in the proximal
gastrectomy group, respec-tively. The above
indicators were 12, 76, (263±15)minutes, 27, 61, 45, 43, 82, 4, 2, 23(18,32), 4, 1, 3, 1, 4 in the total
gastrectomy group, respectively. There were significant differences in the surgical approach, operation
time, volume of intraoperative
blood loss and the number of
lymph nodes harvest between the two groups ( χ2=63.94, t=-25.50, χ2=11.19, Z=-5.62, P<0.05). There was no significant difference in the length of proximal margin or radical
surgery outcome between the two groups ( χ2=0.11, Z=-0.95, P>0.05) and there was no significant difference in the
anastomotic leakage, anastomotic
stricture, incision
infection, pleural
infection or effusion, abdominal
infection or
ascites between the two groups ( P>0.05). (2) Follow-up and
survival. All the 170
patients were followed up for 89(64,106)months. Of the 170
patients, the 5-year overall
survival rates were 43.8% and 35.5% of the Siewert type Ⅱ and Ⅲ AEG
patients, respectively, showing no significant difference between them ( χ2=0.87, P>0.05). Of the
patients with Siewert type Ⅱ AEG, the 5-year overall
survival rates were 41.7% and 54.3% in the
patients with proximal
gastrectomy and the total
gastrectomy, respectively, showing no significant difference between them ( χ2=1.05, P>0.05). Of the
patients with Siewert type Ⅲ AEG, the 5-year overall
survival rates were 31.3% and 37.5% in the
patients with proximal
gastrectomy and the total
gastrectomy, respectively, showing no significant difference between them ( χ2=0.33, P>0.05). The 5-year overall
survival rates were 39.0% and 44.2% in the proximal
gastrectomy group and the total
gastrectomy group, respectively, showing no significant difference between the two groups ( χ2=0.63, P>0.05). Of the
patients in TNM stage Ⅰ, stage Ⅱ, stage Ⅲ, the 5-year overall
survival rates were 65.3%, 36.3%, 27.1% in the proximal
gastrectomy group, versus 83.3%, 48.0%, 39.7% in the total
gastrectomy group, showing no signifi-cant difference between the two groups ( χ2=0.02, 1.50, 1.21, P>0.05). (3)
Analysis of
prognostic factors. Results of univariate
analysis showed that pathological N staging, degree of
tumor differen-tiation and radical
surgery outcome were related factors influencing
prognosis of AEG
patients (
hazard ratio=1.71, 1.70, 2.85, 95%
confidence interval as 1.16-2.60, 1.15-2.50, 1.58-5.14, P<0.05). Results of
multivariate analysis showed that pathological N staging and radical
surgery outcome were independent factors influencing
prognosis of AEG
patients (
hazard ratio=1.55, 2.18, 95%
confidence interval as 1.05-2.31, 1.18-4.02, P<0.05).
Conclusions:
There is no significant difference in the
prognosis of Siewert type Ⅱ and Ⅲ AEG
patients undergoing proximal
gastrectomy or total
gastrectomy. Proximal
gastrectomy can be used for the
treatment of advanced Siewert type Ⅱ and Ⅲ AEG.