Department of General and Upper G.I. Surgery, University of Verona, Verona, Italy.
Department of Surgery, Erasmus MC-University Medical Centre Rotterdam, Rotterdam, The Netherlands.
Dis Esophagus. 2022 Aug 13;35(8). doi: 10.1093/dote/doab090.
Optimal surgical treatment for Siewert type II esophagogastric junction adenocarcinoma is debated. The aim of this study was to compare transhiatal extended gastrectomy (TEG) and transthoracic esophagectomy (TTE). Patients with Siewert type II tumors who underwent a resection by TEG or TTE in two centers (Erasmus University Medical Center, Rotterdam, and University of Verona) between 2014 and 2019 were identified. To limit selection bias, patients were matched for baseline characteristics and compared with a multivariable logistic regression model. Some 159 patients treated by TEG (60 patients, 37.7%) or TTE (99 patients, 62.3%) were included. Patients in the TEG group were older, had less tumor invasion of the esophagus, and were more often excluded from neoadjuvant therapy. Post-operative morbidity was comparable (P = 0.88), while 90-day mortality was higher after TEG (90-day mortality 10.0% in TEG group vs. 2.0% in TTE group P = 0.01). R0 resection was achieved in 83.3% of patients after TEG and in 97.9% after TTE (P < 0.01), with the proximal resection margin involved in 16.6% of patients after TEG versus 0 in TTE group (P < 0.01). The 3-year overall survival was comparable (TEG: 36.5%, TTE: 48.4%, P = 0.12). At multivariable analysis, (y)pT category was an independent risk factor for 3-year recurrence. After matching, TEG was still associated with an increased risk of incomplete tumor resection (P = 0.03) and proximal margin involvement (P < 0.01), while there were no differences in post-operative morbidity (P = 0.56) and mortality (P = 0.31). Our data suggest that patients with Siewert type II tumors treated by TEG are exposed to a higher risk of positive proximal resection margin compared to TTE.
对于 Siewert Ⅱ型食管胃结合部腺癌的最佳手术治疗方法存在争议。本研究旨在比较经胸食管切除术（TTE）和经胸扩大胃切除术（TEG）。在 2014 年至 2019 年期间，在两个中心（鹿特丹伊拉斯姆斯大学医学中心和维罗纳大学）接受 TEG 或 TTE 切除的 Siewert Ⅱ型肿瘤患者被确定。为了限制选择偏倚，对患者进行了基线特征匹配，并通过多变量逻辑回归模型进行了比较。共纳入 159 例接受 TEG（60 例，37.7%）或 TTE（99 例，62.3%）治疗的患者。TEG 组患者年龄较大，食管侵犯程度较轻，且更多地被排除在新辅助治疗之外。术后发病率相当（P=0.88），但 TEG 后 90 天死亡率更高（TEG 组 90 天死亡率为 10.0%，TTE 组为 2.0%，P=0.01）。TEG 组 83.3%的患者达到 R0 切除，TTE 组为 97.9%（P<0.01），TEG 组 16.6%的患者近端切缘受累，而 TTE 组为 0（P<0.01）。3 年总生存率相当（TEG：36.5%，TTE：48.4%，P=0.12）。多变量分析显示，（ypT）分期是 3 年复发的独立危险因素。匹配后，TEG 仍与不完全肿瘤切除（P=0.03）和近端切缘受累（P<0.01）的风险增加相关，而术后发病率（P=0.56）和死亡率（P=0.31）无差异。我们的数据表明，与 TTE 相比，接受 TEG 治疗的 Siewert Ⅱ型肿瘤患者近端切缘阳性的风险更高。
