The Surgical Treatment Analysis Of105Cases Of Adenocarcinoma Of Gastroesophageal Junction Patients

Background and purpose:Over the past decades, epidemiological investigation showed that the morbidity of adenocarcinoma of gastroesophageal junction(AEG) increased, for which in special anatomy position, more subtle in early lesions, lacking of specific symptoms, the relatively poor prognosis especially for elder people. This study aims to explore the relative factors of survival prognosis for AEG elder patients’ on the basis of summering the surgical treatment AEG clinical data from the First Affiliated Hospital of Guangxi Medical University.Methods:Retrospective analysis of surgical treatment Siewert type collection of Guangxi Medical University First Affiliated Hospital and the data collection include the type Ⅱ and type Ⅲ AEG patients105cases, male79cases, female26case. Comparing different classification, stages, the operation of esophageal cut margin path after surgery and negative influence of survival time.The follow-up time continued1to5years. Survival rate and survival curves drawings use the Kaplan-meier method, univariate factor prognostic analysis using Log-rank test and multivariate factors prognostic analysis the COX proportional hazards model.Results:During thses cases, radical surgery were87cases, palliative resection18cases, In accordance with the seventh edition of AJCC stage:Phase Ⅰ were8cases (7.62%), Phase Ⅱ23cases (21.90%), Phase Ⅲ46cases (43.81%), Ⅳ28(26.67%) Operation cure rate was82.86%.The overall survival of this group patients in5years is24.80%. Logistic regression showed that Siewert type Ⅱ esophageal cut edge positive and surgery path have nothing to do.(P>0.05).In single factor analysis the cut edge positive patients with prognosis5-year surial was significantly lower than the cut edge negative patients (P=0.001). All the stomach to excise (TG) and proximal stomach to excise (PG)5year survival rates were15.20%,30.40%(P=0.005). Lymph node metastasis rate than50%of the patients to58.10%at3years, and lymph node metastasis rate>50%of the patients3-year survival is only12.90%(P=0.001). In many factors analysis prognosis signifiant prognostic factors were tumor node metastasis (TNM) stage (P=0.001, OR=3.967,95%CI2.472～6.378), metastatic lymph node ratio (P=0.001, OR=2.893,95%CI:1.683～4.976) and cut edge (P=0.02,OR=0.239,95%CI:0.071-0.802), the extent of radical surgery (P=0.014, OR=3.356,95%CI:1.271～8.860), the degree of tumor differentiation (P=0.013, OR=1.638,95%CI:1.114～2.543), these are independent prognostic factors.Conclusions:TNM staging, tumor AEG positive nodes, radical surgery transfer rate, esophageal cut margin of negative, organization differentiation degree are the important factors affecting the prognosis. Surgery does not affect the path on the margin of a radical resection cut results, should be in radical premise Siewert points formulated according to type individual operation path. The proximal stomach resection is the cure rate was high, less complications.