Effect Of Surgical Approach On Survival Prognosis Of Siewert Type Ⅰ/Ⅱ Adenocarcinoma Of The Esophagogastric Junction

Background:Adenocarcinoma of the esophagogastric junction(AEG)is a common type of GI malignancy that originates near the esophagogastric junction.The latest TNM staging 8th edition standardizes the staging of AEG in the chapter of esophageal cancer and gastric cancer,if the tumor center is located below EGJ(including 2cm)and invades EGJ,then refer to esophageal cancer staging;if the tumor center is located more than 2cm below EGJ and invades EGJ,then refer to gastric cancer staging.aEG,because of its special anatomical location,its genotyping,pathological characteristics and biological behavior are different from those of The genotyping,pathological characteristics and biological behavior of AEG are different from those of adenocarcinoma of esophagus alone or gastric adenocarcinoma.Surgical resection is the basis of treatment for AEG,however,there are still some controversies regarding the surgical access,resection scope,and lymph node dissection scope.Objective:The aim of this study was to investigate the optimal surgical approach for Siewert type Ⅰ/Ⅱ AEG.Although several studies have been conducted,the findings have not been consistent,and the optimal surgical approach for Siewert type Ⅱ AEG in particular remains controversial.Methods:A total of 223 patients with Siewert type I/II AEG were selected from January 2012 to January 2015 in the same surgical treatment group in the Department of Thoracic Surgery of Shandong First Medical University and confirmed to have Siewert type Ⅰ/Ⅱ AEG by preoperative electrogastroscopy and postoperative pathology,and divided into two groups:transthoracic surgery group and transthoracic abdominal hand group.The data were analyzed using SPSS 26.0 software,and the measurement data were expressed as mean(standard deviation)values or median(lower quartile,upper quartile)using the Mann Whitney U test;the categorical data were expressed as values(percentages)using the Pearson chi-square test,the continuity correction formula,or the Fisher test.The Kaplan-Meier method was used to estimate survival curves,and log-rank tests were used to test for differences in survival;P<0.05 was considered a statistically significant difference.The COX proportional risk regression model was used for univariate and multivariate analyses,Factors with P<0.2 in the univariate analysis were included in the multifactor analysis.Results:The survival rates of the transthoracic and transthoracoabdominal groups were counted.The 3-year cumulative survival rates were 51.9%and 59.7%in the transthoracic and transthoracoabdominal groups,respectively.The 5-year cumulative survival rates were 36.4%versus 48.6%for the two groups,respectively,with no statistically significant difference.The median survival time for both was 54.0 months versus 36.6 months.3-year cumulative survival rates for patients undergoing surgery in the transthoracic versus transthoracic-abdominal groups in patients with Siewert type Ⅰ AEG were 54.2%and 53.8%,respectively,and 5-year cumulative survival rates for both groups were 31.3%and 42.3%,respectively,with no statistically significant difference.The 3-year cumulative survival rates of the operated patients were 49.5%and 63.0%,respectively,and the 5-year cumulative survival rates of the two groups were 38.8%and 52.2%,respectively,with a statistically significant difference.Conclusion:To ensure adequate proximal margin safety distance,treatment of Siewert type Ⅰand Siewert type Ⅱ AEG should be done by thoracic surgery.Due to the difference in the pattern of lymph node metastasis between the two,the transthoracic approach is suitable for Siewert type Ⅰ patients and the transthoracic-abdominal approach is suitable for Siewert type Ⅱ,especially progressive stage patients.