| Objective: To investigate the clinical efficacy of proximal gastrectomy and total gastrectomy for Siewert type Ⅱ/Ⅲ adenocarcinoma of esophagogastric junction(AEG),in order to provide reference for the selection of surgical methods for Siewert type Ⅱ/Ⅲ adenocarcinoma of esophagogastric junction.Methods: Retrospective cohort study was used.Pathological data of 119 patients with Siewert type Ⅱ/Ⅲ AEG admitted to the First Affiliated Hospital of Wannan Medical College from December 2014 to January 2017 were collected.There were 90 males and29 females;The median age was 69 years and the age range was from 48 to 83 years.Of119 patients,62 cases were undergoing proximal gastrectomy and were assigned to the proximal gastrectomy group and 57 cases were undergoing total gastrectomy were assigned to total gastrectomy group.Observation and collection indicators:(1)operation and postoperative related conditions.(2)Follow-up and survival situations.(3)Analysis of factors affecting prognosis and survival of patients.Follow-up data were collected through reexamination,outpatient clinic,telephone and other means to understand the survival status of patients.The follow-up period was up to October 2022.Measurement data with normal distribution were showed as Mean ± SD,and comparison between groups was anlyzed by using t test.The data of skewed distribution were expressed as M(Q1,Q3),and the Mann-Whitney U test was used for comparison between groups.The count data were expressed as absolute logarithms or percentages,and the Chi-square test or Fisher’s exact probability method was used for comparison between groups.Rank sum test was used to analyse rank datas.Kaplan-Meier method was used to draw the survival curve and Log-Rank test was used for survival analysis and depict survival curves and Log-Rank test was used for the survival analysis.Univariate and multivariate analyses were performed by COX regression analysis.The factors which P <0.05 in univariate analysis were included in the multivariate analysis.Results:(1)Operation and postoperative conditions :operation time of proximal gastrectomy group,operation method of laparoscopic gastrectomy group and open gastrectomy group,the case of intraoperative blood loss(≤50ml,>50ml),the degree of radical treatment(R0,R1/R2),the number of lymph nodes obtained and the presence or absence of postoperative complications were(204.27±48.20)min,11,51 cases,44,18 cases,19,43 cases,61,1 case,17(13,20)cases,6,56 cases,respectively.In the total gastrectomy group,the above indexes were(229.93±45.17)min,14 and 43 cases,29 and 28 cases,32 and 25 cases,54 and 3 cases,20(16,27.5)cases,11 and 46 cases respectively.There were statistically significant differences in operation time,intraoperative blood loss,number of lymph nodes obtained between the two groups(t=2.989,P=0.003;χ~2= 5.055,P=0.025;χ~2= 7.882,P= 0.005;Z=-2.634,P=0.008).There were no statistically significant differences in surgical methods,radical treatment degree and the presence or absence of postoperative complications between the two groups(P>0.05).(2)The follow-up and survival circumstances: All 119 patients were followed up for 34(11,71)months.Among the 119 patients,the 5-year overall survival rate of Siewert type II AEG patients was 68.2%,and 5-year overall survival rate of Siewert type III AEG patients was 52.8%,and the difference was statistically significant(χ~2=4.402,P=0.036).The 5-year overall survival rates of Siewert type II patients were undergoing proximal gastresectomy and total gastresectomy were 68.6% and 67.7%respectively.There was no significant difference between the two groups(χ~2=0.106,P=0.745).The 5-year overall survival rates of Siewert type III patients who were undergoing proximal gastrectomy and total gastrectomy were 59.3% and 46.2%severally.There was no significant difference between the two groups(χ~ 2=0.630,P=0.427).The 5-year overall survival rates of patients in the proximal gastresectomy group and the total gastresectomy group were 64.5% and 57.9% apartly,and there was no significant difference between the two groups(χ~2=0.779,P=0.377).In the proximal gastrectomy group,the 5-year overall survival rates of TNM stage I,II and III were 88.2%,73.7% and 42.3% respectively.In the total gastrectomy group,the above indexes were 71.4%,72.2% and 46.9% respectively.There was no significant difference between the two groups(χ~2=1.618,0.027,0.034;P=0.203,0.870,0.855).(3)Analysis of factors affecting the prognosis of patients: Single factor analysis showed that Siewert parting,the American society of anesthesiologists(ASA)classification,pathological pathology T stage,pathological pathology N stage,tumor long diameter,radical degree of tumor is related to the factors affecting the prognosis of patients with Siewert type Ⅱ/Ⅲ AEG(HR(Hazard Ratio)= 1.839,2.085,3.173,3.471,2.375,4.588;95%CI(95% Confidence Interval)is 1.028～3.289,1.076～4.039,1.418～7.102,1.879～6.412,1.006～5.608,1.636～12.865,P<0.05).Multivariate analysis showed that ASA classification,pathological pathological pathology T stage,pathological pathology N stage and radical treatment degree were independent factors affecting the prognosis of AEG patients(hazard ratio(HR(Hazard Ratio)=2.459,2.790,2.288,9.421;95%CI were1.217～4.966,1.015～7.669,1.124～4.658,2.966～29.922;P<0.05).Conclusion: There is no significant difference in prognosis and clinical efficacy between proximal gastrectomy and total gastrectomy in patients with Siewert type Ⅱ/Ⅲ AEG.In consequently,Siewert type II/ III AEG is a feasible treatment method for proximal gastrectomy. |
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