Comparison of the efficacies of total gastrectomy and proximal gastrectomy for the treatment of Siewert type II and III adenocarcinoma of the esophagogastric junction

Objective To compare the clinical efficacies of total gastrectomy (TG) and proximal gastrectomy (PG) in treating Siewert type Ⅱ and Ⅲ adenocarcinoma of the esophagogastric junction (AEG).Methods The clinical data of 63 patieuts with Siewert type Ⅱ and Ⅲ AEG who were admitted to the First Affiliated Hospital of Anhui Medical University from June 2012 to October 2012 were retrospectively analyzed.All the patients were divided into the TG group (33 cases) and the PG group (30 cases).The efficacy of radical resection,recovery of gastrointestinal function,postoperative esophageal reflux,postoperative tumor recurrence and postoperative quality of life of the 2 groups were compared.The count data and the measurement data were analyzed using the chisquare test and the t test,respectively.Results The numbers of patients who received R0 and R1 resection in the TG group were 32 and 1,which wcre significantly different from 22 and 8 in the PG group (x2 =5.369,P ＜ 0.05).The numbers of patients who received grade A,B,C TG were 28,3 and 2,which were significantly different from 15,5 and 10 in the PG group (x2=10.177,P ＜0.05).The lengths of proximal resection margins were (4.1 ± 1.4) cm in the TG group and (3.9 ± 1.6) cm in the PG group,with no significant difference between the 2 groups (t =0.666,P ＞ 0.05).The length of distal resection margin,number of lymph nodes resected,lymph nodes with positive expression were (8.1 ±2.6)cm,25 ±4,11 ±3 in the TG group,and (4.2 ±2.6)cm,21 ±4 and 8 ±4 in the PG group,with significant differences between the 2 groups (t =6.043,4.300,3.274,P ＜0.05).Tbe time for bowel sound restoration,time to first flatus,time to diet and duration of postoperative hospital stay were (1.3±0.5)days,(3.1±0.7)days,(4.7±1.0)daysand (10.0 ± 2.0) days in the TG group,and (1.6± 0.5) days,(3.5 ± 0.7) days,(5.3 ± 1.2) days and (12.0 ± 2.0) days,with significant differences between the 2 groups (t =-2.443,-2.059,-2.078,-4.037,P ＜ 0.05).The levels of total bilirubin,indirect bilirubin,bile acid,RDQ scores and GERD-Q scores at postoperative month 6 were (13 ± 10) μmol/L,(7 ± 6) μmol/L,(20 ± 12)μmol/L,14 ±3 and 9.7 ±2.3 in the TG group,and (41 ± 18) μmol/L,(26 ± 15) μmol/L,(204 ± 88) μmol/L,19 ± 5 and 12.0 ± 2.5,with ignificant differences between the 2 groups (t =-7.544,-6.251,-11.379,-4.765,-3.882,P ＜ 0.05).The levels of serum carcinoembryonic antigen at postoperative month 6 were (3.8 ± 2.6)μg/L in the TG group and (5.4 ± 2.0)μg/L in the PG group,with significant difference (t =-2.611,P＜0.05).Conclusion TG is superior to PG for the treatment of Siewert type Ⅱ and Ⅲ AEG in aspects of radical resection,perioperative recovery,seversity of gastroesophageal reflux and tumor recurrence. Key words: Adenocarcinoma of the esophagogastric junction ;  Gastrectomy;  Safety;  Efficacy