Department of General, Visceral and Transplantation Surgery, University Hospital Heidelberg, Im Neuenheimer Feld 110, 69120, Heidelberg, Germany.
Department of Medical Oncology, National Center for Tumor Diseases, University of Heidelberg, Im Neuenheimer Feld 460, 69120, Heidelberg, Germany.
Gastric Cancer. 2018 Mar;21(2):303-314. doi: 10.1007/s10120-017-0746-1. Epub 2017 Jul 6.
The optimal surgical approach for adenocarcinoma directly at the esophagogastric junction (AEG II) is still under debate. This study aims to evaluate the differences between right thoracoabdominal esophagectomy (TAE) (Ivor-Lewis operation) and transhiatal extended gastrectomy (THG) for AEG II.
From a prospective database, 242 patients with AEG II (TAE, n = 56; THG, n = 186) were included and analyzed according to characteristics and perioperative morbidity and mortality and overall survival (chi-square, Mann-Whitney U, log-rank, Cox regression).
Groups were comparable at baseline with exception of age. Patients older than 70 years were more frequently resected by THG (p = 0.003). No differences in perioperative morbidity (p = 0.197) and mortality (p = 0.711) were observed, including anastomotic leakages (p = 0.625) and pulmonary complications (p = 0.494). There was no significant difference in R0 resection (p = 0.719) and number of resected lymph nodes (p = 0.202). Overall median survival was 38.4 months. Survival after TAE was significantly longer than after THG (median OS not reached versus 33.6 months, p = 0.02). Multivariate analysis revealed pN-category (p < 0.001) and type of surgery (p = 0.017) as independent prognostic factors. The type of surgery was confirmed as prognostic factor in locally advanced AEG II (cT 3/4 or cN1), but not in cT1/2 and cN0 patients.
Our single-center experience suggests that patients with (locally advanced) AEG II tumors may benefit from TAE compared to THG. For further evaluation, a randomized trial would be necessary.
胃食管结合部腺癌（AEG II）的最佳手术入路仍存在争议。本研究旨在评估右胸腹联合食管切除术（TAE）（Ivor-Lewis 手术）与经食管裂孔扩大胃切除术（THG）治疗 AEG II 的差异。
从一个前瞻性数据库中，纳入了 242 例 AEG II 患者（TAE 组，n=56；THG 组，n=186），并根据特征、围手术期发病率和死亡率以及总生存率进行分析（卡方检验、Mann-Whitney U 检验、对数秩检验、Cox 回归）。
两组在基线时具有可比性，除年龄外。70 岁以上的患者更常接受 THG 切除（p=0.003）。两组围手术期发病率（p=0.197）和死亡率（p=0.711）无差异，包括吻合口漏（p=0.625）和肺部并发症（p=0.494）。R0 切除率（p=0.719）和切除淋巴结数（p=0.202）无显著差异。中位总生存期为 38.4 个月。TAE 后的生存时间明显长于 THG（中位 OS 未达到 vs 33.6 个月，p=0.02）。多变量分析显示 pN 分期（p<0.001）和手术类型（p=0.017）为独立预后因素。手术类型被确认为局部晚期 AEG II（cT 3/4 或 cN1）的预后因素，但在 cT1/2 和 cN0 患者中不是。
我们的单中心经验表明，与 THG 相比，（局部晚期）AEG II 肿瘤患者可能从 TAE 中获益。为了进一步评估，需要进行随机试验。
