Sugita Shizuki, Kinoshita Takahiro, Kuwata Takeshi, Tokunaga Masanori, Kaito Akio, Watanabe Masahiro, Tonouchi Akiko, Sato Reo, Nagino Masato
Department of Gastric Surgery, National Cancer Center Hospital East, 6-5-1, Kashiwanoha, Kashiwa, Chiba, 277-8577, Japan.
Division of Surgical Oncology, Department of Surgery, Nagoya University Graduate School of Medicine, Nagoya, Japan.
Surg Endosc. 2021 Jan;35(1):340-348. doi: 10.1007/s00464-020-07406-w. Epub 2020 Feb 5.
Insufficient information is available about the long-term outcomes of patients with Siewert type II adenocarcinoma of the esophagogastric junction (AEG) who undergo laparoscopic transhiatal approach (LTH). Here we evaluated the oncological safety of LTH for patients with Siewert type II AEG compared with the open transhiatal approach (OTH).
Subjects included 79 patients with Siewert type II AEG who underwent gastrectomy combined with lower esophagectomy from 2008 to 2018 at our institution. Overall survival (OS), recurrence-free survival (RFS), status of adjuvant chemotherapy, late-phase complications, and recurrence patterns were compared between the OTH (n = 29) and LTH groups (n = 43).
The median observation periods were 60 months (6-120 months) and 36 months (1-88) for the OTH and LTH groups, respectively. The 5-year OS rates were significantly different: 74% (95% CI 71-77%) and 98% (95% CI 97-99) in the OTH and LTH groups (HR 0.10, 95% CI 0.01-0.83), respectively, though the OTH group included more patients with advanced disease. After stratification, according to pathological stage to adjust for selection bias, the 5-year OS and RFS rates were longer, but not significantly different among patients in the LTH group with pStage III (HR 0.42, 95% CI 0.05-3.47; HR 0.47, 95% CI 0.10-2.12, respectively). Recurrence patterns were similar in the both groups.
Long-term outcomes of the LTH group were not inferior to those of the OTH group, suggesting the possibility of LTH as a treatment option for selected patients with Siewert type II AEG.
关于采用腹腔镜经裂孔入路（LTH）治疗的食管胃交界部（AEG）Siewert II型腺癌患者的长期预后，目前可用信息不足。在此，我们评估了LTH与开放经裂孔入路（OTH）相比，治疗Siewert II型AEG患者的肿瘤学安全性。
研究对象包括2008年至2018年在我院接受胃切除术联合食管下段切除术的79例Siewert II型AEG患者。比较OTH组（n = 29）和LTH组（n = 43）的总生存期（OS）、无复发生存期（RFS）、辅助化疗情况、晚期并发症及复发模式。
OTH组和LTH组的中位观察期分别为60个月（6 - 120个月）和36个月（1 - 88个月）。两组的5年OS率有显著差异：OTH组为74%（95%CI 71 - 77%），LTH组为98%（95%CI 97 - 99）（HR 0.10，95%CI 0.01 - 0.83），尽管OTH组中晚期疾病患者更多。分层后，根据病理分期调整选择偏倚，LTH组pStage III患者的5年OS和RFS率更长，但无显著差异（HR分别为0.42，95%CI 0.05 - 3.47；HR 0.47，95%CI 0.10 - 2.12）。两组的复发模式相似。
LTH组的长期预后不劣于OTH组，提示LTH有可能作为部分Siewert II型AEG患者的一种治疗选择。
