| Objective: This study is to explore the necessity of total stomach surgery from the metastasis of lymph nodes in the pyloric area(lymph nodes in the upper and lower pylorus),and analyze the related risk factors of lymph node metastasis in the pyloric area.And to compare and analyze the difference in survival rate of patients with Siewert type II esophagogastric junction adenocarcinoma treated by two surgical methods: total gastrectomy through abdominal approach and proximal gastrectomy through abdominal approach.Methodes: A retrospective study was used to collect the clinical data of 254 patients who were diagnosed with Siewert type II AEG in the gastrointestinal surgery department from January 2015 to January 2018 in Yijishan Hospital of Wannan Medical College.The surgical approach of the patients was transabdominal.The approach was divided into 131 cases in total gastrectomy group and 123 cases in proximal gastrectomy group according to different surgical methods,and follow-up was conducted based on clinical case data.After adjusting the baseline level,according to the clinical pathological results,according to whether there are lymph node metastasis in the upper and lower pylorus area,the patients were divided into positive group and negative group.The proportion of the positive group was calculated,the survival rate of the two groups was compared,and the related risk factors were analyzed.To compare the survival rate of patients with Siewert type II AEG after proximal gastrectomy and total gastrectomy.Results:(1)In the total gastrectomy group,the metastasis rates of upper and lower pyloric lymph nodes were 6.1%(8/131)and 9.2(12/131),and the proportion of positive lymph nodes was 15.6%(28/180)and 5.8%(28/485).The positive lymph nodes accounted for 3.2%(28/867)of the total gastric positive lymph nodes.(2)According to the presence or absence of metastasis in the upper and lower pyloric area lymph nodes,the suprapyloric area lymph nodes and the subpyloric area lymph nodes are divided into positive and negative groups.The 1-year survival rates of the positive and negative suprapyloric lymph nodes are 75% and 85.4%,The 3-year survival rates were 25% and67%,and the differences were statistically significant(P<0.001).The 1-year survival rates of the subpyloric lymph node positive group and negative group were 75% and85.7%,and the 3-year survival rates were 41.7% and 68.1%.The differences were statistically significant(P<0.001).Significance test was carried out by Log-rank test,and the results showed that metastasis of lymph nodes in the suprapyloric area and subpyloric area were both high-risk factors for the prognosis of patients with SiewertⅡ type Ⅱ AEG(P<0.05).(3)Vascular invasion is a high risk factor for lymph node metastasis in the suprapyloric area(P<0.05),and nerve invasion and vascular invasion are high risk factors for lymph node metastasis in the subpyloric area(P<0.05).(4)Successful follow-up of254 patients with Siewert type Ⅱ AEG(131 in the total gastrectomy group and 123 in the proximal gastrectomy group).The 1-year survival rates of the total gastrectomy group and the proximal gastrectomy group were 84.0% and 84.6%,respectively,The 3-year survival rates were 66.4% and 65.9%,respectively,and the differences were not statistically significant(P=0.741 and P=0.759).Significance test was performed by Logrank test,and the results showed that total gastrectomy and proximal gastrectomy There was no difference in the postoperative survival rate of the two surgical methods(P=0.997).Conclusion: For patients with Siewert type II AEG,when the tumor invades nerves and vessels,the rate of lymph node metastasis in the pyloric area is higher.Lymph node metastasis in the superior and inferior pylorus region suggests that patients with Siewert type II AEG have a poor prognosis.Total gastrectomy via abdominal approach and proximal gastrectomy are two surgical methods for the treatment of Siewert type II AEG.Total gastrectomy cannot improve the survival rate of patients. |
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