Division of Visceral Surgery, Department of Surgery, University of Geneva, Hospitals and School of Medicine, Rue Gabrielle-Perret-Gentil 4, 1205, Geneva, Switzerland.
Updates Surg. 2019 Sep;71(3):401-409. doi: 10.1007/s13304-019-00665-w. Epub 2019 Jun 26.
The minimal length of proximal margin (PM) in esophagogastric junction cancer has not been established yet and its impact on patient survival remains unclear. Pubmed, Embase and Scopus databases were searched for "adenocarcinoma of the esophagogastric junction", "adenocarcinoma of the gastroesophageal junction" and "cardia cancer", each combined with "proximal margin". English written studies that specified PM length in AEG were included. Survival data in relation to PM were extracted. 13 studies, that were all retrospective case series, with a total number of 2648 patients met inclusion criteria and were analyzed. While 93% of 230 patients with Siewert type I had esophagectomy, 69% of 1270 patients with Siewert type II and 93% of 872 patients with Siewert type III had transhiatal extended gastrectomy. Minimal PM length was treated by five studies and ranged between 2 and 6 cm. While three studies defined minimal PM by the necessary length to obtain R0 resection, two studies found minimal PM length significantly associated with survival. Multivariate analyses revealed in two studies an independent impact of PM on survival, whereas one study did not found any significant relation between PM and survival. One study showed that PM length was significantly associated with survival in T2-4N0-2 tumors, but not in T1 or N3 tumors. In conclusion, available retrospective studies did not allow a conclusion for a minimal length of PM and showed no clear evidence for an impact of PM length on survival. Taking into consideration available data and the shrinkage phenomen, a PM > 2 cm might be necessary to obtain a sufficient PM.
胃食管结合部腺癌近端切缘（PM）的最小长度尚未确定，其对患者生存的影响仍不清楚。检索了 Pubmed、Embase 和 Scopus 数据库，使用的检索词为“胃食管结合部腺癌”、“胃食管交界腺癌”和“贲门癌”，每个词都与“近端切缘”结合使用。纳入了专门规定 AEG 近端 PM 长度的英文书写研究。提取了与 PM 相关的生存数据。共有 13 项研究符合纳入标准，均为回顾性病例系列研究，共纳入 2648 例患者。230 例 Siewert Ⅰ型患者中 93%行食管切除术，1270 例 Siewert Ⅱ型患者中 69%行经胸扩大胃切除术，872 例 Siewert Ⅲ型患者中 93%行经胸扩大胃切除术。5 项研究探讨了 PM 的最小长度，范围为 2-6cm。其中 3 项研究根据获得 R0 切除的必要长度来定义最小 PM，而 2 项研究发现最小 PM 长度与生存显著相关。多变量分析显示，有 2 项研究发现 PM 对生存有独立影响，而有 1 项研究未发现 PM 与生存之间有任何显著关系。有 1 项研究显示，PM 长度与 T2-4N0-2 肿瘤的生存显著相关，但与 T1 或 N3 肿瘤无关。总之，现有的回顾性研究无法确定 PM 的最小长度，也没有明确证据表明 PM 长度对生存有影响。考虑到现有数据和收缩现象，PM>2cm 可能是获得足够 PM 的必要条件。
