Department of General Surgery, The First Affiliated Hospital of Army Medical University, No. 30 Gaotanyan Street, Chongqing, 400038, China.
Department of Gastrointestinal Surgery, Three Gorges Hospital, Chongqing University, Chongqing, China.
Surg Endosc. 2022 Jul;36(7):5055-5066. doi: 10.1007/s00464-021-08867-3. Epub 2021 Nov 10.
The potential advantage of laparoscopic gastrectomy (LG) compared with open gastrectomy (OG) for serosa-invasive (pT4a) Siewert type II and III adenocarcinoma of the esophagogastric junction (AEG) remains uncertain. Thus, the purpose of this study was to investigate the short- and long-term outcomes of LG compared to OG for pT4a Siewert type II/III AEG cancers.
We retrospectively evaluated 283 patients with pathological confirmed T4a Siewert type II and type III AEG who underwent LG or OG in our center between January 2004 and September 2015. The short- and long-term outcomes were compared between the groups using a 1:1 matched propensity score matching method (PSM).
The LG group had a longer operation time, less estimated blood loss, less time to first flatus, less time to start liquid diet, less time to first ambulation, and shorter length of incision than the OG group. The conversion rates were 5.4% in the LG groups. There was no significant difference in the overall complication rate between the LG and OG groups. The 5-year overall survival (OS) and the 5-year disease-free survival (DFS) were comparable between the LG and OG groups (35.4% vs 32.1%, p = 0.541; 34.1% vs 31.0%, p = 0.523, respectively). There was no significant difference in the recurrence rate and pattern between the LG and OG groups.
Laparoscopic gastrectomy is associated with better short-term outcomes and similar long-term outcomes for pT4a Siewert type II/III AEG. This study reveals that LG could be a safe and feasible option for pT4a Siewert type II/III AEG compared to OG.
腹腔镜胃切除术（LG）与开腹胃切除术（OG）相比，在治疗侵犯浆膜（pT4a）的食管胃交界部（AEG）Siewert Ⅱ型和Ⅲ型腺癌方面具有潜在优势，但这一优势尚不确定。因此，本研究旨在探讨 LG 与 OG 治疗 pT4a Siewert Ⅱ/Ⅲ型 AEG 癌症的短期和长期疗效。
我们回顾性评估了 2004 年 1 月至 2015 年 9 月期间在我院接受 LG 或 OG 治疗的 283 例病理证实的 T4a Siewert Ⅱ型和Ⅲ型 AEG 患者。采用 1:1 倾向评分匹配（PSM）方法比较两组的短期和长期疗效。
LG 组的手术时间较长，但失血量较少，首次肛门排气时间、开始流质饮食时间、首次下床活动时间和切口长度较短。LG 组的中转开腹率为 5.4%。LG 组和 OG 组的总体并发症发生率无显著差异。LG 组和 OG 组的 5 年总生存率（OS）和无病生存率（DFS）相当（35.4% vs 32.1%，p=0.541；34.1% vs 31.0%，p=0.523）。LG 组和 OG 组的复发率和模式无显著差异。
与 OG 相比，LG 治疗 pT4a Siewert Ⅱ/Ⅲ型 AEG 具有更好的短期疗效和相似的长期疗效。本研究表明，与 OG 相比，LG 可能是治疗 pT4a Siewert Ⅱ/Ⅲ型 AEG 的一种安全可行的选择。
