ObjectiveTo systematically evaluate the efficacy and safety of proximal gastrectomy (PG) versus total gastrectomy (TG) for the treatment of Siewert type Ⅱ/Ⅲ adenocarcinoma of the esophagogastric junction (AEG). MethodsPubMed, The Cochrane Library, Web of Science, EMbase, CNKI, Wanfang, and VIP databases were searched for literature comparing the efficacy and safety of PG and TG for the treatment of Siewert type Ⅱ/Ⅲ AEG. The search period was from database inception to March 2023. Meta-analysis was performed using Review Manager 5.4 software. ResultsA total of 23 articles were included, including 16 retrospective cohort studies, 5 prospective cohort studies, and 2 randomized controlled trials. The total sample size was 2 826 patients, with 1 389 patients undergoing PG and 1 437 patients undergoing TG. Meta-analysis results showed that compared with TG, PG had less intraoperative blood loss [MD=?19.85, 95%CI (?37.20, ?2.51), P=0.02] and shorter postoperative hospital stay [MD=?1.23, 95%CI (?2.38, ?0.08), P=0.04]. TG had a greater number of lymph nodes dissected [MD=?6.20, 95%CI (?7.68, ?4.71), P<0.001] and a lower incidence of reflux esophagitis [MD=3.02, 95%CI (1.24, 7.34), P=0.01]. There were no statistically significant differences between the two surgical approaches in terms of operative time, postoperative survival rate (1-year, 3-year, 5-year), and postoperative overall complications (P>0.05). ConclusionPG has advantages in terms of intraoperative blood loss and postoperative hospital stay, while TG has advantages in terms of the number of lymph nodes dissected and the incidence of reflux esophagitis. There is no significant difference in long-term survival between the two surgical approaches.
Objective
To explore the risk factors of recurrence and metastasis in patients with Siewert Ⅱ and Ⅲ adenocarcinoma of esophagogastric junction (AEG) after radical gastrectomy.
Methods
A retrospective study was conducted to collect the clinical data of 146 patients with type Ⅱ and Ⅲ AEG who underwent radical gastrectomy from January 2010 to January 2013 in the Nanjing First Hospital of Nanjing Medical University. The factors affected the recurrence and metastasis of the patients after the radical gastrectomy were analyzed by the unconditional logistic regression analysis.
Results
The 146 AEG patients were followed up for 3–84 months, with the median follow-up time of 48 months. During the follow-up period, there were 59 cases suffered from recurrence and metastasis. The recurrence and metastasis time was 1–50 months after radical gastrectomy, with the median time of 17 months after radical gastrectomy. The results of multivariate logistic regression analysis showed that, the histological grade (OR=4.478, P=0.015), the number of positive lymph nodes (OR=2.886, P<0.001), and vascular invasion (OR=5.334, P=0.003) were independent risk factors for the recurrence and metastasis of AEG patients after radical gastrectomy. Patients with low tumor histological grade (G3+G4), a large number of positive lymph nodes, and vascular invasion were more likely to have recurrence and metastasis after radical gastrectomy.
Conclusions
The histological grade of tissue, number of positive lymph nodes, and vascular invasion are important factors in predicting the recurrence and metastasis of Siewert Ⅱ/Ⅲ AEG patients after radical gastrectomy.
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.
