To Evaluate The Influence Of Different Surgical Resection And Length Of Proximal Margin On The Prognosis Of Patients With Adenocarcinoma Of Esophagogastric Junction

Purpose:To compare the influence of different surgical resection and length of proximal margin on the prognosis of patients with adenocarcinoma of esophagogastric junction(AEJ). The aim of the study was to investigate the optimal surgical resection for adenocarcinoma of esophagogastric junction.Patients and Methods:1. Retrospectively analysised the clinicopathological features and prognosis of the patients with Siewert type II/III adenocarcinoma of esophagogastric junction who underwent surgery and pathologically diagnosed in Department of Digestive Surgery, Xijing Hospital of Digestive Diseases were collected from May 2008 to March 2015.2. From May 2008 to March 2014, patients with Siewert type II adenocarcinoma of esophagogastric junction were enrolled in two groups which were matched according to age, gender, tumor size, TNM stage and differentiation status. The prognosis of the two groups were analyzed and compared.3. From September 2009 to December 2014, patients with Siewert type II/III adenocarcinoma of esophagogastric junction were enrolled in four groups which were matched according to tumor size, differentiation status, tumor depth and lymph node metastasis. The prognosis of the four groups were analyzed and compared.Results: 1. The patient age ranged from 22-90 years(median, 61 years; mean, 60.5 years). The ratio of male to female was 6.7:1. 51.2% patients were poor or mucinous differentiation. 63.5% tumor size?5cm. 78.7% patients were T3-4 stage. The overall survival rate was 49.5%, 3-year overall survival rate was 61.3%, 5-year overall survival rate was 51.7%. In multivariate analysis, age, tumor size, T stage and N stage were the independent factors of prognosis of Siewert type II/III adenocarcinoma of esophagogastric junction following surgery.2. 3-year and 5-year overall survival rates in the proximal gastrectomy and total gastrectomy groups were no significant difference. There were also no statistical differences between the proximal and total gastrectomy groups in 3-year overall survival rates in patients with different tumor size, degree of differentiation, T stage and AJCC stage.3. There was no significant difference among the prognosis of the four groups. Further, using the different cut off length of gross proximal margin, the four groups were classified into two groups. The results showed that there was no significant difference between the prognosis of margin?1cm and margin>1cm, margin?2cm and margin>2cm, and margin?3cm and margin>3cm, respectively.Conclusions: 1. For Siewert type II adenocarcinoma of esophagogastric junction patients, the proximal gastrectomy can provide same benefit from the total gastrectomy on the prognosis.2. The proximal margin length of more than 1.0 cm could not improve the survival of patients with Siewert type II/III adenocarcinoma of esophagogastric junction with abdominal-transhiatal approach and R0 resection.