关键词: 食管胃交界部腺癌, 经胸入路手术, 经胸腹入路手术, 预后

Abstract: Background and purpose: With the decrease in the incidence of esophageal cancer and gastric cancer, the incidence of adenocarcinoma of the esophagogastric junction (AEG) has shown a slow upward trend in recent years. This study aimed to investigate the surgical treatment for Siewert type Ⅰ and type Ⅱ AEG, lymph node dissection and prognosis. Methods: From Jan 2012 to Jan. 2014, a total of 240 patients with Siewert type Ⅰ and type Ⅱ AEG confirmed by preoperative electronic gastroscopy and postoperative pathology in the same surgical treatment group were selected and divided into Siewert typeⅠgroup and type Ⅱ group. The survival rate was calculated by the life table method and the single factor survival analysis. Kaplan-Meier method was used to analyze the univariate survival rate. Log-rank test was used to analyze the difference in survival rate between the groups. Cox regression model was used for multivariate survival analysis of prognostic factors. According to the operation methods, the patients were divided into transthoracic group and transthoracic abdominal group. Kaplan-Meier method was used for univariate analysis. Results: The 3-year and 5-year overall survival rates of Siewert typeⅠwere 36.4% and 25.0%, respectively. There were significant differences in TNM international stage, lymph node stage, number of lymph node dissection and prognosis of neoadjuvant chemotherapy (P<0.05). The 3-year and 5-year overall survival rates of Siewert type Ⅱ were 41.7% and 29.9%, respectively. There were significant differences in the prognosis of patients with different TNM international stages, lymph node stages, surgical approaches and neoadjuvant chemotherapy (P<0.05). Cox proportional hazards regression model analysis showed that TNM staging (HR=3.877, 95% CI: 0.765-1.949, P=0.019), lymph node staging (HR=21.753, 95% CI: 0.745-1.971, P=0.007), the number of lymph node dissection (HR=4.113, 95% CI: 1.511-4.832, P=0.025) and neoadjuvant chemotherapy (HR=6.711, 95% CI: 1.511-3.977, P=0.041) were independent factors affecting the prognosis of patients with Siewert type Ⅰ AEG. TNM staging (HR=6.387, 95% CI: 0.775-1.932, P=0.031), lymph node staging (HR=2.343, 95% CI: 0.730-2.112, P=0.038), surgical approach (HR=2. 991, 95% CI: 1. 592-5.871, P=0.035), lymph node dissection (HR=3.179, 95% CI: 1.511-4.832, P=0.032) and neoadjuvant chemotherapy (HR=3.459, 95% CI: 1.732-4.977, P=0.025) were independent factors affecting the prognosis of patients with Siewert type Ⅱ AEG. Conclusion: The treatment of Siewert type Ⅰ and type Ⅱ AEG should be completed by thoracic surgery. The pathological staging refers to the Union for International Cancer Control (UICC) 8th edition of esophageal cancer staging. Transthoracic approach is suitable for patients with Siewert type Ⅰ and limited period. The transthoracic abdominal approach is suitable for patients with Siewert type Ⅱ and advanced stage. The safety of the resection range of the upper margin for Siewert type Ⅰ and type Ⅱ AEG surgery and the degree of lymph node metastasis are important factors for the prognosis of AEG. For patients with advanced AEG, neoadjuvant chemotherapy should be used as much as possible.

Key words: Adenocarcinoma of the esophagogastric junction, Transthoracic surgery, Transthoracic abdominal surgery, Prognosis