scholarly journals Proximal Gastrectomy versus Total Gastrectomy for Siewert Type II Adenocarcinoma of the Esophagogastric Junction: A Comprehensive Analysis of Data from the SEER Registry

2019 ◽  
Vol 2019 ◽  
pp. 1-11 ◽  
Author(s):  
Kaixuan Zhu ◽  
Yingying Xu ◽  
Jiaxin Fu ◽  
Farah Abdidahir Mohamud ◽  
Zongkui Duan ◽  
...  
Keyword(s):  
Total Gastrectomy ◽  
Surgical Approach ◽  
Esophagogastric Junction ◽  
Proximal Gastrectomy ◽  
Locally Advanced ◽  
Cox Proportional Hazards Model ◽  
Type Ii ◽  
Siewert Type ◽  
Siewert Type Ii ◽  
Significant Difference

Background. To determine the ideal surgical approach (total gastrectomy (TG) vs. proximal gastrectomy (PG)) for Siewert type II adenocarcinoma of the esophagogastric junction (AEG), we searched and analyzed the Surveillance, Epidemiology, and End Results (SEER) data. Methods. Patients with Siewert type II AEG treated by TG or PG were identified from the 2004–2014 SEER dataset. We obtained the patients’ overall survival (OS) and cancer-specific survival (CSS) and stratified the patients by surgical approach. We performed a propensity score 1 : 1 matching (PSM) analysis and a univariate and multivariate Cox proportional hazards model. Results. A total of 2,217 patients with 6th AJCC stage IA–IIIB Siewert type II AEG was examined: 1,584 patients (71.4%) underwent PG, and 633 patients (28.6%) underwent TG. The follow-up time was 1–131 months. OS favored total gastrectomy before the PSM analysis (χ2=3.952, p=0.047), but after this analysis, there was no significant difference between TG and PG (χ2=2.227, p=0.136). The univariate and multivariate analyses identified age as an independent factor, and an X-tail analysis revealed 70 years as a cut-off point. The patients aged≥70 years obtained a significant long-term OS benefit from PG compared to TG (χ2=8.245, p=0.004), and those aged<70 years showed no difference between TG and PG (χ2=0.167, p=0.682). Conclusions. PG showed an equivalent survival benefit to TG in both the early and locally advanced stages of Siewert type II AEG. For elderly patients, PG is strongly recommended because of its clearer OS benefit compared to TG.

scholarly journals Novel abdominal approach for dissection of advanced type II/III adenocarcinoma of the esophagogastric junction: a new surgical option

2018 ◽  
Vol 47 (1) ◽  
pp. 398-410 ◽  
Author(s):  
Can Hu ◽  
Hao-te Zhu ◽  
Zhi-yuan Xu ◽  
Jian-fa Yu ◽  
Yi-an Du ◽  
...  
Keyword(s):  
Lymph Node ◽  
Survival Rate ◽  
Postoperative Complications ◽  
Total Gastrectomy ◽  
Surgical Approach ◽  
Esophagogastric Junction ◽  
Abdominal Cavity ◽  
Type Ii ◽  
Siewert Type ◽  
Siewert Type Ii

Objective The optimal surgical approach for Siewert type II adenocarcinoma of the esophagogastric junction (AEG) is controversial. In this study, we evaluated the outcomes of total gastrectomy for Siewert type II/III AEG via the left thoracic surgical approach that is used at our center. Methods We identified 41 patients with advanced AEG in our retrospective database and analyzed their 3-year survival rate, upper surgical margin, postoperative complications, and index of estimated benefit from lymph node dissection. Results The 3-year overall survival rate of the whole group was 63%, but no difference was observed between Siewert type II and III AEGs. Esophageal exposure and lymphadenectomy were sufficient. Eight patients developed postoperative complications, but none of the patients developed anastomotic leakage. Dissection of lymph node station Nos. 19 and 110 may be necessary for patients with Siewert type II AEG. Multivariate analysis revealed that the cT category was the only independent risk factor. Conclusions Total gastrectomy via an approach from the abdominal cavity into the thoracic cavity may be an optimal surgical technique for advanced Siewert type II AEG.

Nutritional Benefit of Proximal Gastrectomy for Siewert Type II/III Adenocarcinoma of the Esophagogastric Junction

2017 ◽  
Vol 225 (4) ◽  
pp. e164-e165
Author(s):  
Shuhei Komatsu ◽  
Daisuke Ichikawa ◽  
Toshiyuki Kosuga ◽  
Kazuma Okamoto ◽  
Eigo Otsuji
Keyword(s):  
Esophagogastric Junction ◽  
Proximal Gastrectomy ◽  
Type Ii ◽  
Siewert Type ◽  
Siewert Type Ii

scholarly journals Short-Term Clinical Efficacy of Neoadjuvant Chemotherapy Combined With Laparoscopic Gastrectomy for Locally Advanced Siewert Type II and III Adenocarcinoma of the Esophagogastric Junction: A Retrospective, Propensity Score-Matched Study

2021 ◽  
Vol 11 ◽  
Author(s):  
Qing Feng ◽  
Du Long ◽  
Ming-shan Du ◽  
Xiao-song Wang ◽  
Zhen-shun Li ◽  
...  
Keyword(s):  
Risk Factor ◽  
Neoadjuvant Chemotherapy ◽  
Propensity Score ◽  
Esophagogastric Junction ◽  
Independent Risk Factor ◽  
Locally Advanced ◽  
Type Ii ◽  
Short Term ◽  
Siewert Type ◽  
Siewert Type Ii

BackgroundLaparoscopic gastrectomy (LG) has been increasingly used for the treatment of locally advanced Siewert type II and III adenocarcinoma of the esophagogastric junction (AEG). However, whether LG can achieve the same short-term efficacy in the treatment of patients who receive neoadjuvant chemotherapy (NACT) remains controversial. Thus, the aim of this study was to investigate the clinical outcomes of NACT combined with LG for Siewert type II and III AEG.MethodsThis retrospective study identified patients with locally advanced Siewert type II and III AEG diagnosed between May 2011 and October 2020 using the clinical tumor-node-metastasis (cTNM) staging system. The short-term outcomes were compared between the matched groups using a 1:3 propensity score matching (PSM) method, which was performed to reduce bias in patient selection.ResultsAfter PSM, 164 patients were selected, including 41 in the NACT group and 123 in the LG group. The baseline characteristics were similar between the two groups. Compared with the LG group, the NACT group exhibit a smaller tumor size and significantly less advanced pathological tumor classification and nodal classification stages. The time to first flatus of the NACT group was significantly shorter, but the hospital stay was significantly longer than that of the LG group. The NACT group showed similar overall (29.3% vs 25.2%, P=0.683), systemic (24.4% vs 21.1%, P=0.663), local (12.2% vs 9.8%, P=0.767), minor (19.5% vs 19.5%, P=1.000) and major (9.8% vs 5.7%, P=0.470) complications as the LG group. Subgroup analyses showed no significant differences in most stratified parameters. Operation time≥ 300 minutes was identified as an independent risk factor for overall complications. Age≥ 60 years was identified as an independent risk factor for major complications.ConclusionNACT combined with LG for AEG does not increase the risk of postoperative morbidity and mortality compared with LG.

scholarly journals How to decide surgical procedure for esophagogastric junction cancer?

2020 ◽  
Vol 10 (4) ◽  
pp. 104-108
Author(s):  
Yasuyuki Seto ◽  
Hiroharu Yamashita
Keyword(s):  
Surgical Procedure ◽  
Esophagogastric Junction ◽  
Resection Margin ◽  
Proximal Gastrectomy ◽  
Remnant Stomach ◽  
Type Ii ◽  
Siewert Type ◽  
Siewert Type Ii ◽  
Node Metastasis ◽  
Esophagogastric Junction Cancer

Standard surgical procedure for esophagogastric junction cancer, especially adenocarcinoma, has still remained controversial. Various procedures has been allowed and applied for Siewert type II tumors. Negative long resection margin had been regarded as essential in decision on the procedure. Recent papers have, however, shown the priority of invasion length to each side (esophagus and stomach), because it relates the frequency and sites of lymph node metastasis to be dissected. And, the size of remnant stomach is, also, important when a proximal gastrectomy is considered.

scholarly journals The Preoperative Lymphocyte to Monocyte Ratio Predicts Clinical Outcome In Resected Patients With T2-4N0-3M0 Siewert Type II/III Adenocarcinoma Of The Esophagogastric Junction

2021 ◽  
Author(s):  
Chen Ke ◽  
Jiawei Zhang ◽  
Bo Chen ◽  
Maoming Xiong ◽  
Aman Xu
Keyword(s):  
High Risk ◽  
Esophagogastric Junction ◽  
Critical Role ◽  
Clinicopathological Parameters ◽  
Monocyte Count ◽  
Type Ii ◽  
Siewert Type ◽  
Siewert Type Ii ◽  
Lymphocyte To Monocyte Ratio ◽  
Significant Difference

Abstract Background Inflammation has a critical role in the pathogenesis and progression of cancer. The lymphocyte to monocyte ratio (LMR) could be a new biomarker in various tumors. Aims We analyzed the LMR with clinicopathological parameters and outcome in resected patients with T2-4N0-3M0 Siewert type II/III of advanced adenocarcinoma of the esophagogastric junction (AEG) . Methods A total of five hundred and seventy-one patients with Siewert type II/III of AEG between Jan 2006 and Jun 2012 were included in this retrospective study. Kaplan-Meier curves were used to calculate the cancer-specific survival (CSS). Univariate and multivariate Cox-regression analyses were performed to evaluate the prognostic factors. Results We set 3.64 as the cut-off level based on the receiver operating characteristic curve. The preoperative absolute lymphocyte count tended to decrease in ‘LMR≤3.64’ group, and the preoperative absolute monocyte count tended to decrease in ‘LMR＞3.64’ group. The decreased preoperative LMR was significantly associated with decreased CSS in univariate (HR:2.311, 95%CI:1.639-3.254, P=0.008) and multivariate analysis (HR:1.642, 95%CI:1.242-2.171, P=0.027 ). According to the treatment regimen(surgery alone versus surgery and adjuvant chemotherapy), no significant difference in the 5-year CSS was identified in ‘high-risk’ group (LMR≤3.64) (HR: 1.121, 95%CI: 0.733-1.725, P=0.605). Conclusions The LMR might be an independent prognostic marker for CSS in resected patients with T2-4N0-3M0 Siewert type II/III of advanced AEG. When the ‘high-risk’ patients with LMR≤3.64 were analyzed, no benefit of adjuvant 5-FU-based chemotherapy could be found.

Surgical approach for Siewert type II adenocarcinoma of the esophagogastric junction: transthoracic or transabdominal? A retrospective analysis in a single center

2018 ◽  
pp. 1-6
Keyword(s):  
Gastric Cancer ◽  
Survival Rate ◽  
Hospital Stay ◽  
Surgical Approach ◽  
Esophagogastric Junction ◽  
Type Ii ◽  
Single Center ◽  
Siewert Type ◽  
Siewert Type Ii ◽  
Shorten Hospital Stay

Background: Adenocarcinoma of the esophagogastric junction (AEG) is a special type of challenging carcinoma between esophageal and gastric cancer with controversy in the diagnosis, treatment and prognosis. The Siewert classification is widely accepted by the majority of scholars at home and abroad, in which, type I and type III AEG are usually treated based on the guidelines for esophageal cancer and gastric cancer, respectively. However, the surgical approach topatients with type II AEG still remains controversial. In this study, we intended to realize the different surgical approach for Siewert type II AEG treatment by analyzing the data retrospectively. Methods: Patients with Siewert type II AEG were collected in Guangdong General Hospital from 2004 to 2014. We compared the clinicopathological outcome and prognosis in transthoracic(TT) and transabdominal(TA) approach. Results: A total of 158 patients with Siewert type II AEG were enrolled. Overall medium survival was 52 months and the 5-year survival rate was 39.1%. The 5-year survival rate was comparable between TT and TA group (35.1% vs 43.2%,p>0.05), while more lymph nodes were dissected in TA group (23.7±0.2 vs 18.1±0.3, p<0.05), with less postoperative complications (14.3%vs28.4%,p<0.05) and shorten hospital stay(12±4 d vs 15±7 d, p<0.05). Conclusion: For Siewert type II AEG patients, there is no significant difference in survival outcome as treated with TT or TA approach. However, fewer lymph nodes dissection number was conducted in transthoracic group, with a higher incidence of postoperative complication. Therefore, we consider that transabdominal approach is more suitable for patients with Siewert type II AEG to achieve an optimal extent of lymph node dissection, and reduce the incidence of complication, shorten hospital stay and promote the recovery. But our study is only a single-center, retrospective, small sample clinical study that represents our previous clinical treatment experience and we need more multi-center, prospective, and a large sample of clinical studies to be validated.

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