Li Zonglin, Jiang Huaiwu, Chen Jin, Jiang Yifan, Liu Yi, Xu Linxia
Department of Gastrointestinal Surgery, The Affiliated Hospital of Southwest Medical University, Luzhou, China.
Department of Gastrointestinal Surgery, Sichuan Mianyang 404 Hospital, Mianyang, China.
Front Oncol. 2022 Apr 29;12:813242. doi: 10.3389/fonc.2022.813242. eCollection 2022.
The optimal surgical approach, whether transabdominal (TA) or transthoracic (TT), for Siewert type II adenocarcinoma of the esophagogastric junction (AEG) remains controversial. This study compares the efficacy of TA and TT surgical approaches for Siewert type II AEG.
Studies comparing the surgical and oncological outcomes of TA and TT surgical approaches for Siewert type II AEG up to June 2021 were systematically searched on the Web of Science, PubMed, Embase, and Cochrane Library. A pooled analysis was performed for the available data regarding the baseline features, surgical, and oncological outcomes. The RevMan 5.3 software was used to perform the statistical analysis. Quality evaluation and publication bias were also conducted.
Twelve studies with a total of 2,011 patients, including 985 patients in the TA group and 1,026 patients in the TT group, were included in this study. In the pooled analysis, the surgical outcomes, namely, operative time (MD = -54.61, 95% CI = -123.76 to 14.54, P = 0.12), intraoperative blood loss (MD = -28.85, 95% CI = -71.15 to 13.46, P = 0.18), the number of dissected lymph nodes (MD = 1.90, 95% CI = -1.32 to 5.12, P = 0.25), postoperative complications (OR = 0.84, 95% CI = 0.65 to 1.07, p = 0.16), anastomotic leakage rate (OR = 1.02, 95% CI = 0.63 to 1.65, p = 0.93), and postoperative death rate (OR = 0.89, 95% CI = 0.46 to 1.72, p = 0.73), and the oncological outcomes, namely, overall recurrence rate (OR = 0.75, 95% CI = 0.37 to 1.50, p = 0.41), 3-year overall survival (OS) rate (OR = 1.19, 95% CI = 0.54 to 2.65, p = 0.66), and 5-year OS rate (OR = 1.21, 95% CI = 0.84 to 1.74, p = 0.30) of the two groups were all comparable.
Both TA and TT surgical approaches are appropriate for Siewert type II AEG, and neither has a significant advantage in terms of short- and long-term outcomes. However, more high-quality randomized controlled trials are needed to confirm this conclusion.
对于食管胃交界部（AEG）Siewert II型腺癌，最佳手术方式是经腹（TA）还是经胸（TT）仍存在争议。本研究比较TA和TT手术方式治疗Siewert II型AEG的疗效。
在Web of Science、PubMed、Embase和Cochrane图书馆系统检索截至2021年6月比较TA和TT手术方式治疗Siewert II型AEG的手术和肿瘤学结局的研究。对有关基线特征、手术和肿瘤学结局的可用数据进行汇总分析。使用RevMan 5.3软件进行统计分析。还进行了质量评估和发表偏倚分析。
本研究纳入12项研究，共2011例患者，其中TA组985例，TT组1026例。汇总分析中，两组的手术结局，即手术时间（MD = -54.61，95%CI = -123.76至14.54，P = 0.12）、术中出血量（MD = -28.85，95%CI = -71.15至13.46，P = 0.18）、清扫淋巴结数目（MD = 1.90，95%CI = -1.32至5.12，P = 0.25）、术后并发症（OR = 0.84，95%CI = 0.65至1.07，p = 0.16）、吻合口漏发生率（OR = 1.02，95%CI = 0.63至1.65，p = 0.93）和术后死亡率（OR = 0.89，95%CI = 0.46至1.72，p = 0.73），以及肿瘤学结局，即总复发率（OR = 0.75，95%CI = 0.37至1.50，p = 0.41）、3年总生存率（OS）（OR = 1.19，95%CI = 0.54至2.65，p = 0.66）和5年OS率（OR = 1.21，95%CI = 0.84至1.74，p = 0.30）均具有可比性。
TA和TT手术方式均适用于Siewert II型AEG，在短期和长期结局方面两者均无显著优势。然而，需要更多高质量的随机对照试验来证实这一结论。
