Objective To compare the quality of life (QOL) of advanced Siewert type Ⅱ adenocarcinoma esophagogastric junction (AEG) patients treated by the total gastrectomy, traditional proximal gastrectomy or proximal gastrectomy with gastric tube reconstruction opertations, and to provide some clinical basis for the choice of surgical methods for AEG. Methods A total of 90 patients with Siewert type Ⅱ AEG were retrospectively collected from the Affiliated Hospital of North Sichuan Medical College. Patients were divided into 3 groups according to different surgical methods (n=30 in each group), a total gastrectomy group (23 males, 7 females, aged 47-79 years), a traditional proximal gastrectomy group (treated with the traditional proximal gastrectomy procedure, 19 males, 11 females, aged 44-80 years), and a narrow gastric tube group (treated with the proximal gastrectomy with gastric tube reconstruction procedure, 25 males, 5 females, aged 47-83 years). The Chinese version of Quality of Life Questionnaire Core-30 (QLQ-C30) and Quality of Life Questionnaire Oesophagogastric-25 (QLQ-OG25) designed by European Organization for Research and Treatment of Cancer (EORTC) were used to collect the patients’ information in the three groups about their QOL during the first six months and one year after the three procedures. Results There was no statistical difference in the clinical data among the three groups (all P>0.05). QOL during the first six months after the operations assessed by the QLQ-C30 questionnaire table showed that the narrow gastric tube group was significantly best in total QOL, physical function, fatigue, and emotional function among the three groups (all P<0.05). The total gastrectomy group was the worst in role function, dyspnea, fatigue and diarrhea among the three groups (all P<0.05). The traditional proximal gastrectomy group had a worse evaluation in lose of appetite than the other two groups (P<0.05). QOL during the first six months after the operations assessed by the QLQ-OG25 questionnaire table showed that the traditional proximal gastrectomy group had a significantly worse evaluation in palirrhea than the other two groups (both P<0.05). The total gastrectomy group had a significantly worse evaluation in anxiety than the other two groups (both P<0.05). QOL during the first year after the operations assessed by the QLQ-C30 questionnaire table showed that the narrow gastric tube group had a significantly highest evaluation in total QOL physical function and emotional function among the three groups (all P<0.05). The total gastrectomy group had a significantly worst evaluation in diarrhea among the three groups (P<0.05). QOL during the first year after operations assessed by QLQ-OG25 questionnaire table showed that the traditional proximal gastrectomy group had a significantly worse evaluation in palirrhea than the other two groups (all P<0.05). Conclusion The narrow tubular esophagogastric anastomosis is better than the total gastrectomy and the traditional proximal gastrectomy for the treatment of the advanced Siewert type Ⅱ adenocarcinoma of esophagogastric junction, so this operation is worth being recommended.
ObjectiveTo investigate therapeutic effect and influence on survival of complete laparoscopic transesophageal hiatus approach approach and transabdominal combined thoracotomy approach in treatment of Siewert type Ⅱesophageal gastric junction adenocarcinoma (AEG).MethodsFrom January 2012 to December 2014, the patients with Siewert type Ⅱ AEG were collected in the Department of General Surgery (Gastrointestinal Surgery) of Weifang People’s Hospital, then who were designed into a transabdominal group and transabdominal combined thoracotomy group according to the operative approach method. The intraoperative and postoperative statuses were compared between these two groups.ResultsIn this study, 142 patients with Siewert type Ⅱ AEG were included, 83 in the transabdominal group and 59 in the transabdominal combined thoracotomy group. There were no significant differences in the baseline data such as the gender, age, preoperative histological differentiation, TNM stage, etc. between the two groups (P>0.05). Compared with the transabdominal combined thoracotomy group, in terms of the operation time, the volumes of intraoperative blood loss and blood transfusion, and the proportion of patients with blood transfusion were better (P<0.05); the postoperative hospitalization time, time to use analgesics, time of the first activity out of bed, and time of removed electrocardiographic monitoring were also earlier (P<0.05); the numbers of lymphadenectomy and metastatic lymph nodes were less (P<0.05) in the transabdominal group. But there was no significant difference in the rate of lymph node metastasis between the two groups (P>0.05). The total incidence of complications in the transabdominal group was lower than that in the transabdominal combined thoracotomy group (χ2=9.871, P=0.002). The median survival time was 39 months in the transabdominal group and 34 months in the transabdominal combined thoracotomy group. The survival had no significant difference between the two groups by the Kaplan-Meier analysis (χ2=0.281, P=0.596). The result of multivariate analysis showed that the TNM stage and lymph node positive rate were the independent factors influencing the survival of the patients with Siewert type Ⅱ AEG.ConclusionsAccording to results of this study, it is safe and effective for patients with Siewert type Ⅱ AEG to adopt a complete laparoscopic transabdominal approach. For elderly patients with poor cardiopulmonary function who can not tolerate transthoracic surgery, it could reduce postoperative complications and improve safety.
ObjectiveTo compare the clinical efficacy of different surgical approaches for Siewert type Ⅱ adenocarcinoma of esophagogastric junction (AEG). MethodsThe clinical data of the patients with Siewert type Ⅱ AEG who received sugeries in the Department of Thoracic Surgery of Gansu Provincial People's Hospital from August 2014 to December 2019 were retrospectively analyzed. The patients were divided into two groups according to the surgical approach: a transabdominal group (transabdominal diaphragmatic esophageal hiatus approach) and a combined group (thoracoabdominal combined with right thoracic approach). Perioperative clinical data and postoperative follow-up data were collected to compare the short- and long-term efficacy of the two groups. Results A total of 87 patients were enrolled. There were 48 patients (31 males and 17 females, with an average age of 60.85±8.47 years) in the transabdominal group, and 39 patients (25 males and 14 females, with an average age of 61.13±8.51 years) in the combined group. There was no statistical difference between the two groups in the baseline indicators such as gender, age, tumor size and stage (P>0.05). Compared with the combined group, the operation time, intraoperative blood loss, postoperative bed rest time, postoperative total drainage volume were shorter or less, and the visual analogue scale score on the 3rd day after surgery were lower in the transabdominal group (P<0.05). However, the total number of lymph nodes dissected, the number of thoracic lymph nodes dissected and the number of positive thoracic lymph nodes in the combined group were larger than those in the transabdominal group, and the differences were statistically significant (P=0.001). The median survival time in the combined group and transabdominal group was 25.85 months and 20.86 months, respectively. The 3-year overall survival rate of the combined group was higher than that of the transabdominal group (46.2% vs. 38.9%, χ2=5.995, P=0.014). However, there was no statistical difference between the two groups in the postoperative catheter time, esophageal and gastric resection margin distance, number of abdominal lymph nodes dissected, number of positive abdominal lymph nodes, or incidence of postoperative complications (P>0.05). ConclusionFor patients with Siewert type Ⅱ adenocarcinoma of esophagogastric junction, thoracoabdominal combined with right thoracic approach is safe and effective, and has advantages in thoracic lymph node dissection, bringing more benefits to the patients, so it is recommended to be popularized in clinical practice.
ObjectiveTo analyze the impact of resection margin length on postoperative clinical outcomes in patients with Siewert type Ⅱ/Ⅲ adenocarcinoma of the esophagogastric junction (AEG) and to investigate the independent risk factors influencing postoperative positive resection margin. MethodsBased on sample size estimation, 173 patients with AEG admitted to the 980th Hospital of Joint Logistics Support Force of Chinese People’s Liberation Army from July 2022 to January 2025 were prospectively enrolled and divided into 3 groups according to the proximal resection margin length: <20 mm group, 20–30 mm group, and >30 mm group. Baseline data were compared among the 3 groups, and differences in clinical outcomes among patients with different resection margin lengths were analyzed. Multivariate logistic regression analysis was used to identify independent risk factors for positive resection margin, and receiver operating characteristic (ROC) curve was used to evaluate the discriminative ability of these independent factors for postoperative positive resection margin. Stratified analysis by resection margin length intervals was performed to quantify the association between proximal resection margin length and risk of positive margin, and subgroup analyses were conducted to explore the consistency of this association across different clinicopathologic subgroups. ResultsThere were no statistically significant differences in baseline data such as gender, age among the three groups (P>0.05). Among the three groups, patients in the 20–30 mm group had the shortest operative time and time to first postoperative ambulation (P<0.05), the lowest percentage of body weight loss (P<0.05) and the highest hemoglobin and albumin levels (P<0.05) on postoperative month 6. Multivariate logistic regression analysis showed that tumor length ≥5 cm [OR (95%CI)=4.500 (2.519, 8.038), P=0.008], poorly differentiated pathological type [OR (95%CI)=3.803 (2.098, 6.882), P=0.026], and resection margin length <20 mm or >30 mm [OR (95%CI)=3.997 (1.819, 8.793), P=0.037; OR (95%CI)=4.202 (1.906, 9.252), P=0.031, respectively] were independent risk factors for postoperative positive resection margin. The areas under the ROC curve for these three factors individually and their combination in predicting positive resection margin were 0.765, 0.726, 0.702, and 0.847, respectively. The risk-stratified analysis for positive resection margins revealed that, compared with a superior resection margin length of 20–25 mm, the risk of margin positivity significantly increased at lengths of 15–20 mm and 30–35 mm [OR (95%CI)=6.609 (1.816, 24.034), P=0.004; OR (95%CI)=6.618 (1.832, 23.973), P=0.004]. Subgroup analyses showed that the correlation between resection margin length and positive margin was more pronounced in patients with tumor length ≥5 cm and poorly differentiated pathology (Pinteraction<0.05). ConclusionsFor patients with Siewert type Ⅱ/Ⅲ AEG, maintaining the superior resection margin length within the 20–30 mm range during surgical resection can ensure oncological radicality while optimizing postoperative recovery and nutritional status. For patients with tumor length ≥5 cm and poorly differentiated pathology, greater emphasis should be placed on accurate measurement and frozen section confirmation during surgery.
Advanced Siewert type Ⅱ adenocarcinoma of the esophagogastric junction (AEG) has a unique anatomical location and exhibits heterogeneous biological behavior resembling both esophageal and gastric cancers. It is associated with a high risk of bidirectional lymphatic metastasis to the abdominal cavity and mediastinum, and is often diagnosed at a relatively advanced stage. Therefore, the establishment of precision surgical treatment strategies for this disease remains challenged by several key issues. Based on the latest clinical evidence, guidelines, and expert consensus from China and abroad, and combined with our institutional clinical experience, this article discusses the individualized selection of surgical approaches, precise definition of the extent of lymphadenectomy, safe threshold for the proximal esophageal resection margin, and strategies for digestive tract reconstruction.