Bates Kelly R, Jacobs Ryan C, Zaza Norah N, Liggett Marjorie R, Rao Saieesh A, Vitello Dominic J, Bentrem David J
Department of Surgery, Northwestern University Feinberg School of Medicine, Chicago, IL, USA.
Department of Surgery, Jesse Brown Veterans Administration Medical Center, Chicago, IL, USA.
Ann Surg Oncol. 2025 May 8. doi: 10.1245/s10434-025-17431-5.
Total gastrectomy and esophagectomy are commonly used surgical approaches for cardia gastric adenocarcinoma (GA) resection. However, the preferred approach remains unclear. The objectives of this study were to identify predictors of receipt of surgical approach type and compare surgical approach outcomes.
Patients with stage IB-IIIC cardia GA from 2004 to 2017 were identified within the National Cancer Database. Patients were compared on the basis of receipt of total gastrectomy versus partial gastrectomy with esophagectomy. Predictors of receiving esophagectomy were identified using multivariable logistic regression. Predictors associated with overall survival (OS) were assessed using a multivariable Cox proportional hazards model.
A total of 9841 patients were included. More patients underwent esophagectomy compared with total gastrectomy (77.2% vs. 22.8%). Surgical approach utilization did not vary significantly over time (p = 0.6). Patients who were non-white or female (OR 0.8, 95% CI 0.7-0.9) were less likely to receive esophagectomy. The median number of lymph nodes resected was greater for total gastrectomy versus esophagectomy (18 vs. 15, p < 0.01). There was no difference in resection margins (93.6% vs. 94.5%, p = 0.3) or 30-day mortality (3.0% vs. 2.5%, p = 0.2). Total gastrectomy and esophagectomy had similar OS (40.2 vs. 40.1 months, p = 0.7). On multivariate analysis, there was no difference in survival for total gastrectomy versus esophagectomy (HR 1.0, 95% CI 0.9-1.0).
Utilization of total gastrectomy and esophagectomy has remained stable over time with esophagectomy being more utilized. These approaches exhibit similar oncologic outcomes for proximal GA. Surgeons should consider long-term outcomes, such as quality of life and nutritional status, when selecting an approach.
全胃切除术和食管切除术是贲门胃腺癌（GA）切除常用的手术方式。然而，首选的手术方式仍不明确。本研究的目的是确定手术方式类型选择的预测因素，并比较手术方式的结果。
在国家癌症数据库中识别出2004年至2017年患有IB-IIIC期贲门GA的患者。根据接受全胃切除术与部分胃切除术加食管切除术的情况对患者进行比较。使用多变量逻辑回归确定接受食管切除术的预测因素。使用多变量Cox比例风险模型评估与总生存期（OS）相关的预测因素。
共纳入9841例患者。与全胃切除术相比，接受食管切除术的患者更多（77.2%对22.8%）。手术方式的使用随时间变化无显著差异（p = 0.6）。非白人或女性患者接受食管切除术的可能性较小（比值比0.8，95%置信区间0.7-0.9）。全胃切除术切除的淋巴结中位数多于食管切除术（18对15，p < 0.01）。切缘情况（93.6%对94.5%，p = 0.3）或30天死亡率（3.0%对2.5%，p = 0.2）无差异。全胃切除术和食管切除术的总生存期相似（40.2个月对40.1个月，p = 0.7）。多变量分析显示，全胃切除术与食管切除术的生存率无差异（风险比1.0，95%置信区间0.9-1.0）。
随着时间推移，全胃切除术和食管切除术的使用保持稳定，且食管切除术的使用更为普遍。这些手术方式对近端GA显示出相似的肿瘤学结果。外科医生在选择手术方式时应考虑长期结果，如生活质量和营养状况。
