Department of Gastrointestinal Surgery, The First Hospital of Jilin University, China.
Department of Gastrointestinal Surgery, The First Hospital of Jilin University, China.
Asian J Surg. 2019 Aug;42(8):805-813. doi: 10.1016/j.asjsur.2018.12.014. Epub 2019 Jan 23.
This study aims to compare laparoscopic total gastrectomy (LTG) with open total gastrectomy (OTG) for treating advanced Siewert type Ⅱ and type Ⅲ adenocarcinoma of esophagogastric junction (AEG).
The data for this study included 872 patients with advanced Siewert type Ⅱ and type Ⅲ AEG who were candidates for undergoing total gastrectomy from January 2012 to December 2017 in Gastrointestinal Surgery Department of the First Hospital of Jilin University. After screening all the patients' data, 722 patients underwent the propensity score match (PSM) and out of them, 685 patients were selected and grouped into LTG group (n = 468) and OTG group (n = 217).
Observing the patients' C reactive protein (CRP) level (p < 0.001) and pain score on postoperative day (POD) 1 (p < 0.001) and POD2 (p < 0.001) showed that the patients in LTG group were less stressed than those in OTG group. Moreover, patients who underwent LTG were able to sooner take liquid food (p < 0.001), get off beds to walk (p < 0.001), restore bowel function (p < 0.001), and had shorter postoperative stay (p < 0.001). On the other hand, these two groups showed no significant difference regarding postoperative complication rate (p = 0.19). The median survival for the LTG and OTG groups was 56 months and 47 months, respectively, and the 5-year overall survival (OS) was 40% and 29.1%, respectively. The LTG group obtained better OS (p < 0.01), with hazard ratio of 0.69 (LTG vs. OTG, 95% confidence interval, 0.52 to 0.91). Moreover, the hazard ratio of Siewert type Ⅱ was 0.79 (95% confidence interval, 0.46 to 1.12) and that of Siewert type Ⅲ was 1.16 (95% confidence interval, 0.78 to 1.54).
It can thus be seen that LTG is a safe and effective method for treating patients with advanced Siewert type Ⅱ and type Ⅲ AEG and patients with Siewert type Ⅱ AEG may benefit more from LTG in the long term.
本研究旨在比较腹腔镜全胃切除术（LTG）与开腹全胃切除术（OTG）治疗食管胃结合部（AEG）Ⅱ型和Ⅲ型进展期 Siewert 腺癌的疗效。
本研究纳入了 2012 年 1 月至 2017 年 12 月在吉林大学第一医院胃肠外科接受全胃切除术治疗的 872 例进展期 Siewert Ⅱ型和Ⅲ型 AEG 患者。经过对所有患者数据的筛选，722 例患者进行了倾向评分匹配（PSM），其中 685 例患者被分为 LTG 组（n=468）和 OTG 组（n=217）。
观察患者 C 反应蛋白（CRP）水平（p<0.001）和术后第 1 天（p<0.001）及第 2 天（p<0.001）的疼痛评分，LTG 组患者的应激反应低于 OTG 组。此外，LTG 组患者更早地开始进食液体（p<0.001）、下床活动（p<0.001）、恢复肠道功能（p<0.001），术后住院时间更短（p<0.001）。另一方面，两组患者的术后并发症发生率无显著差异（p=0.19）。LTG 组和 OTG 组的中位生存时间分别为 56 个月和 47 个月，5 年总生存率（OS）分别为 40%和 29.1%。LTG 组的 OS 更好（p<0.01），风险比为 0.69（LTG 与 OTG，95%置信区间为 0.52 至 0.91）。此外，Siewert Ⅱ型的风险比为 0.79（95%置信区间为 0.46 至 1.12），Siewert Ⅲ型的风险比为 1.16（95%置信区间为 0.78 至 1.54）。
综上所述，LTG 是治疗进展期 Siewert Ⅱ型和Ⅲ型 AEG 患者的安全有效的方法，Siewert Ⅱ型 AEG 患者可能从 LTG 中获益更多。
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