Sorbonne Université, Department of Digestive Surgery, Saint Antoine Hospital, AP-HP, 75012, Paris, France.
Department of Digestive Surgery, Haut-Lévêque University Hospital, Bordeaux, France.
Eur J Surg Oncol. 2019 Dec;45(12):2473-2481. doi: 10.1016/j.ejso.2019.07.022. Epub 2019 Jul 19.
Type II AEG is now considered as oesophageal cancer in the seventh and eighth edition of TNM classification but optimal surgical approach for these tumors remains debated. The objective of the study is to assess and compare surgical and oncological outcomes of two surgical approaches: superior polar oesogastrectomy (SPO) or total gastrectomy (TG) in patients with type II adenocarcinoma of the oesophagogastric junction (AEG).
183 patients with type II AEG treated from 1997 to 2010 in 21 French centers by SPO or TG were included in a multicenter retrospective study. The surgical and oncological outcomes were compared between these two surgical approaches.
A TG was performed in 64 (35%) patients whereas 119 (65%) patients were treated by SPO with transthoracic approach in 100 of them (83.2%) and transhiatal approach with cervicotomy in 19 (16.8%). Surgical outcomes were comparable between the two approaches with a postoperative mortality rate of 4.9% and a severe operative morbidity rate within 30 days of 15.3%. Median survival in patients operated on by TG was of 46 months compared to 27 months in patients treated by SPO (p = 0.118). At multivariate analysis, TG appears to be an independent good prognostic factor compared to SPO (HR = 1.847; p = 0.008). However, TG was also associated with a higher rate of incomplete resection, (12.5% vs 5.9%; p = 0.120).
When TG allows obtaining tumor-free resection margins, this approach should be preferred to SPO.
在第七版和第八版 TNM 分期中，II 型 AEG 现在被认为是食管癌，但这些肿瘤的最佳手术方法仍存在争议。本研究的目的是评估和比较两种手术方法（胃上部切除术[SPO]或全胃切除术[TG]）在 II 型食管胃交界腺癌（AEG）患者中的手术和肿瘤学结果。
183 例 II 型 AEG 患者于 1997 年至 2010 年在 21 个法国中心接受 SPO 或 TG 治疗，纳入多中心回顾性研究。比较两种手术方法的手术和肿瘤学结果。
64 例（35%）患者行 TG，119 例（65%）患者行 SPO，其中 100 例（83.2%）采用经胸入路，19 例（16.8%）采用经颈入路。两种方法的手术结果相当，术后死亡率为 4.9%，30 天内严重手术发病率为 15.3%。TG 组患者的中位生存时间为 46 个月，而 SPO 组患者的中位生存时间为 27 个月（p=0.118）。多因素分析显示，与 SPO 相比，TG 是独立的预后良好因素（HR=1.847；p=0.008）。然而，TG 也与不完全切除的发生率较高相关（12.5%比 5.9%；p=0.120）。
当 TG 能够获得无肿瘤残留的切缘时，应优先选择 TG 而非 SPO。
