Short-term Prognosis Of Total Gastrectomy In Advanced Siewert â…¡ And â…¢ Adenocarcinoma Of The Esophagogastric Junction(A E G)

Objective:To compare the short-term prognosis of total gastrectomy and radical proximal gastrectomy plus pyloroplasty in advanced Siewert II and III adenocarcinoma of the esophagogastric junction(A E G) and provide evidence for the choice of operation methods.Methods:118advanced Siewert Ⅱ and Ⅲ AEG patients who underwent total gastrectomy or radical proximal gastrectomy plus pyloroplasty were retrospectively analyzed and followed up. Nutrition status, reflux symptom index and life quality were compared between two groups (PG group:patients underwent radical proximal gastrectomy plus pyloroplasty, TG group:patients underwent total gastrectomy).72h pH and abnormal reflux events were monitored.Results:No patients died in perioperative period and no positive esophageal surgical margin was observed. The average operation duration of PG group was192.5min and221min in the TG group, and there was significant difference. There was no significant difference in the amount of bleeding during the operation between two groups. The average time of abdominal drainage removal was13.48±5.99days in TG group and14.12±10.36in PG group, and there was no significant difference between two groups. The average hospitalization time was18.48±6.95days in TG group and19.54±11.56days in PG group, and there was no significant difference. There was no significant difference in body weight, HGB and ALB levels between two groups. Incidence rates of reflux, heartburn, chest pain and somnipathy in TG group were significantly lower compared with PG group. No significant difference of atypical reflux symptoms such as hoarseness, cough and nausea between two groups was found. Alkaline reflux was found in both groups. The daily average pH and abnormal reflux frequence in TG group were significantly lower compared with PG group. The frequence of reflux time more than5min was significantly lower in TG group compared with PG group on the third day. The total time of abnormal reflux in TG group was significantly less compared with PG group on the first and third day, and no significant difference was found on the second day. The longest reflux time in TG group was significantly less compared with PG group on the first and third day, and no significant difference was found on the second day.Conclusion:(1)Pyloroplasty contributed to severe duodenogastric reflux due to the disturbance of the integrity of the duodenogastric junction.(2)The entire gastric remnant environment not only the pH were changed due to severe duodenogastric reflux. So the gastric biological function of was little reserved.(3)Alkaline reflux index, reflux symptoms and nutrition index of TG group were more satisfied compared with PG group.(4)Total gastrectomy was recommended for the advanced SiewertⅡand Ⅲ AEG patients.