A Comparison Study of Total Gastrectomy Versus Proximal Gastrectomy for Advanced Esophagogastric Junction Cancer_CHINESE JOURNAL OF BASES AND CLINICS IN GENERAL SURGERY

Authors：

 YULiang ,  LUCheng-yu , YUANAi-hua , CHENWei , ZHANGYi-fan , WUAn-wei

Department of General Surgery, Affiliated Nanjing Hospital/The First Hospital of Nanjing City, Nanjing Medical University, Nanjing 210006, Jiangsu Province, China;

Corresponding?author：

LUCheng-yu, Email: lcy_1234@aliyun.com

Keywords：

Esophagogastric junction cancer; Total gastrectomy; Proximal gastrectomy; Survival rate

DOI：

10.7507/1007-9424.20140270

Video：

Export PDF Favorites Scan Get Citation

Abstract Full text Figures/Tables Video References Cited by

Objective To evaluate the effect of total gastrectomy (TG) and proximal gastrectomy (PG) for the treatment of advanced esophagogastric junction cancer. Methods Clinical data of 273 cases of advanced esophagogastric junction cancer who underwent TG and PG in our hospital from Jan. 2004 to Dec. 2010 were reviewed for retrospective analysis. Operation related indexes, 3-year cumulative survival rate, and 5-year cumulative survival rate were compared and evaluated. Results There was no significant difference between TG group and PG group in intraoperative blood loss, operation time, and hospital stay(P > 0.05), but the number of dissected lymph nodes in TG group was obviously more than those of PG group, and the difference was statistically significant(P=0.000). The postoperative complication rates were 10.3%(12/117)in TG group and 21.8%(34/156) in PG group respectively, which was lower in TG group(χ²=6.353, P < 0.05). The 3-year and 5-year cumulative survival rates of TG group were 58.9% and 34.2%, of PG group were 43.4% and 23.6% respectively, and the 3-year and 5-year cumulative survival rates were all lower in PG group(χ²=5.894, P < 0.05;χ²=5.582, P < 0.05). For patients in stage pT4, pN2, and TNMⅢ, whose tumor size were bigger than 3.0 cm, and patients who had accept chemotherapy, the 3-and 5-year cumulative survival rates of TG group were significantly higher than those of PG group(P < 0.05). However, for patients in stage pT2, pT3, pN0, pN1, pN3, TNMⅠ, TNMⅡ, TNMⅣ, whose tumor size were smaller than 3.0 cm, who had not accept chemotherapy, and patients of any pathological type, there was no statistically significant difference between the 2 groups in 3-year and 5-year cumulative survival rates(P > 0.05). Conclusion For the patients who suffered from advanced esophagogastric junction cancer, TG can improve long-term survival rate, and it can significantly reduce the incidence of postoperative complications and improve postoperative quality of life.

Citation： YULiang, LUCheng-yu, YUANAi-hua, CHENWei, ZHANGYi-fan, WUAn-wei. A Comparison Study of Total Gastrectomy Versus Proximal Gastrectomy for Advanced Esophagogastric Junction Cancer. CHINESE JOURNAL OF BASES AND CLINICS IN GENERAL SURGERY, 2014, 21(9): 1124-1129. doi: 10.7507/1007-9424.20140270 Copy

1.	Krejs GJ.Gastric cancer:epidemiology and risk factors[J]. Dig Dis, 2010, 28(4-5):600-603.
2.	Kim DY, Joo JK, Park YK, et al.Predictors of long-term survival in node-positive gastric carcinoma patients with curative resection[J]. Langenbecks Arch Surg, 2007, 392(2):131-134.
3.	謝洪虎, 呂成余, 陳維, 等.958例胃癌臨床病理資料分析[J]. 中國普外基礎與臨床雜志, 2011, 18(2):153-158.
4.	Siegel R, Naishadham D, Jemal A.Cancer statistics, 2013[J]. CA Cancer J Clin, 2013, 63(1):11-30.
5.	Gronnier C, Piessen G, Mariette C.Diagnosis and treatment of non-metastatic esophagogastric junction adenocarcinoma:what are the current options?[J]. J Visc Surg, 2012, 149(1):e23-e33.
6.	王家鑌, 黃昌明, 盧輝山, 等.聯合脾切除治療胃上部癌No.10淋巴結轉移的療效[J]. 中華胃腸外科雜志, 2009, 12(2):121-125.
7.	Matsuda T, Takeuchi H, Tsuwano S, et al.Optimal surgical management for esophagogastric junction carcinoma[J]. Gen Thorac Cardiovasc Surg, 2014,[Epub ahead of print].
8.	Wen L, Chen XZ, Wu B, et al.Total vs. proximal gastrectomy for proximal gastric cancer:a systematic review and meta-analysis[J]. Hepatogastroenterology, 2012, 59(114):633-640.
9.	王云, 蒲長春, 吳敬章, 等.全胃切除與近側胃切除治療胃底賁門部癌術后生存狀態對比分析[J]. 中國普外基礎與臨床雜志, 2013, 20(11):1272-1278.
10.	Siewert JR, Stein HJ, Feith M.Adenocarcinoma of the esophagogastric junction[J]. Scand J Surg, 2006, 95(4):260-269.
11.	Washington K.7th edition of the AJCC cancer staging manual:stomach[J]. Ann Surg Oncol, 2010, 17(12):3077-3079.
12.	Richter JE.Gastroesophageal reflux disease treatment:side effects and complications of fundoplication[J]. Clin Gastroenterol Hepatol, 2013, 11(5):465-471.
13.	Hoshikawa T, Denno R, Ura H, et al.Proximal gastrectomy and jejunal pouch interposition:evaluation of postoperative symptoms and gastrointestinal hormone secretion[J]. Oncol Rep, 2001, 8(6):1293-1299.
14.	沈朝勇, 楊宏鑫, 張波, 等.近端胃切除術與全胃切除術對食管胃結合部腺癌患者生活質量的影響[J]. 中國普外基礎與臨床雜志, 2013, 20(12):1381-1385.
15.	朱德祥, 秦震聲, 于仁.近端胃切除及全胃切除術治療賁門癌的比較研究[J]. 現代生物醫學進展, 2010, 10(8):1520-1521.
16.	H?lscher AH, Voit H, Buttermann G, et al.Function of the intrathoracic stomach as esophageal replacement[J]. World J Surg, 1988, 12(6):835-844.
17.	Zarate N, Mearin F, Wang XY, et al.Severe idiopathic gastroparesis due to neuronal and interstitial cells of Cajal degeneration:pathological findings and management[J]. Gut, 2003, 52(7):966-970.
18.	An JY, Youn HG, Choi MG, et al.The difficult choice between total and proximal gastrectomy in proximal early gastric cancer[J]. Am J Surg, 2008, 196(4):587-591.
19.	Papachristou DN, Fortner JG.Adenocarcinoma of the gastric cardia.The choice of gastrectomy[J]. Ann Surg, 1980, 192(1):58-64.
20.	王勁, 張隆陶.賁門癌的全胃切除術療效分析[J]. 中國臨床研究, 2013, 26(8):793-794.
21.	黃昌明, 張祥福, 盧輝山, 等.全胃切除術治療胃底賁門癌的遠期療效[J]. 中華外科雜志, 2003, 41(10):729-732.
22.	Takeshita K, Ashikawa T, Tani M, et al.Clinicopathologic features of gastric cancer infiltrating the lower esophagus[J]. World J Surg, 1994, 18(3):428-432.
23.	潘常青, 薛延慶, 彭志海.進展期胃近側癌的淋巴結轉移和手術治療[J]. 中國實用外科雜志, 2000, 20(10):608-610.
24.	官國先, 張祥福, 盧輝山, 等.根治性全胃切除術治療進展期賁門癌的療效評價[J]. 中華普通外科雜志, 2006, 21(8):564-566.
25.	王文睿, 朱立桓, 楊勝生, 等.全胃切除與近端胃切除治療賁門癌的療效對比[J]. 中國熱帶醫學, 2010, 10(6):744-745.
26.	劉文韜, 劉福坤.2002年版日本胃癌治療規范[J]. 中華胃腸外科雜志, 2003, 6(2):131-132.
27.	Harrison LE, Karpeh MS, Brennan MF.Total gastrectomy is not necessary for proximal gastric cancer[J]. Surgery, 1998, 123(2):127-130.
28.	Mann NS, Rachut E.Carcinoma of gastric stump causing afferent loop obstruction and acute pancreatitis[J]. Hepatogastroenterology, 2004, 51(55):184-185.

1. Krejs GJ.Gastric cancer:epidemiology and risk factors[J]. Dig Dis, 2010, 28(4-5):600-603.
2. Kim DY, Joo JK, Park YK, et al.Predictors of long-term survival in node-positive gastric carcinoma patients with curative resection[J]. Langenbecks Arch Surg, 2007, 392(2):131-134.
3. 謝洪虎, 呂成余, 陳維, 等.958例胃癌臨床病理資料分析[J]. 中國普外基礎與臨床雜志, 2011, 18(2):153-158.
4. Siegel R, Naishadham D, Jemal A.Cancer statistics, 2013[J]. CA Cancer J Clin, 2013, 63(1):11-30.
5. Gronnier C, Piessen G, Mariette C.Diagnosis and treatment of non-metastatic esophagogastric junction adenocarcinoma:what are the current options?[J]. J Visc Surg, 2012, 149(1):e23-e33.
6. 王家鑌, 黃昌明, 盧輝山, 等.聯合脾切除治療胃上部癌No.10淋巴結轉移的療效[J]. 中華胃腸外科雜志, 2009, 12(2):121-125.
7. Matsuda T, Takeuchi H, Tsuwano S, et al.Optimal surgical management for esophagogastric junction carcinoma[J]. Gen Thorac Cardiovasc Surg, 2014,[Epub ahead of print].
8. Wen L, Chen XZ, Wu B, et al.Total vs. proximal gastrectomy for proximal gastric cancer:a systematic review and meta-analysis[J]. Hepatogastroenterology, 2012, 59(114):633-640.
9. 王云, 蒲長春, 吳敬章, 等.全胃切除與近側胃切除治療胃底賁門部癌術后生存狀態對比分析[J]. 中國普外基礎與臨床雜志, 2013, 20(11):1272-1278.
10. Siewert JR, Stein HJ, Feith M.Adenocarcinoma of the esophagogastric junction[J]. Scand J Surg, 2006, 95(4):260-269.
11. Washington K.7th edition of the AJCC cancer staging manual:stomach[J]. Ann Surg Oncol, 2010, 17(12):3077-3079.
12. Richter JE.Gastroesophageal reflux disease treatment:side effects and complications of fundoplication[J]. Clin Gastroenterol Hepatol, 2013, 11(5):465-471.
13. Hoshikawa T, Denno R, Ura H, et al.Proximal gastrectomy and jejunal pouch interposition:evaluation of postoperative symptoms and gastrointestinal hormone secretion[J]. Oncol Rep, 2001, 8(6):1293-1299.
14. 沈朝勇, 楊宏鑫, 張波, 等.近端胃切除術與全胃切除術對食管胃結合部腺癌患者生活質量的影響[J]. 中國普外基礎與臨床雜志, 2013, 20(12):1381-1385.
15. 朱德祥, 秦震聲, 于仁.近端胃切除及全胃切除術治療賁門癌的比較研究[J]. 現代生物醫學進展, 2010, 10(8):1520-1521.
16. H?lscher AH, Voit H, Buttermann G, et al.Function of the intrathoracic stomach as esophageal replacement[J]. World J Surg, 1988, 12(6):835-844.
17. Zarate N, Mearin F, Wang XY, et al.Severe idiopathic gastroparesis due to neuronal and interstitial cells of Cajal degeneration:pathological findings and management[J]. Gut, 2003, 52(7):966-970.
18. An JY, Youn HG, Choi MG, et al.The difficult choice between total and proximal gastrectomy in proximal early gastric cancer[J]. Am J Surg, 2008, 196(4):587-591.
19. Papachristou DN, Fortner JG.Adenocarcinoma of the gastric cardia.The choice of gastrectomy[J]. Ann Surg, 1980, 192(1):58-64.
20. 王勁, 張隆陶.賁門癌的全胃切除術療效分析[J]. 中國臨床研究, 2013, 26(8):793-794.
21. 黃昌明, 張祥福, 盧輝山, 等.全胃切除術治療胃底賁門癌的遠期療效[J]. 中華外科雜志, 2003, 41(10):729-732.
22. Takeshita K, Ashikawa T, Tani M, et al.Clinicopathologic features of gastric cancer infiltrating the lower esophagus[J]. World J Surg, 1994, 18(3):428-432.
23. 潘常青, 薛延慶, 彭志海.進展期胃近側癌的淋巴結轉移和手術治療[J]. 中國實用外科雜志, 2000, 20(10):608-610.
24. 官國先, 張祥福, 盧輝山, 等.根治性全胃切除術治療進展期賁門癌的療效評價[J]. 中華普通外科雜志, 2006, 21(8):564-566.
25. 王文睿, 朱立桓, 楊勝生, 等.全胃切除與近端胃切除治療賁門癌的療效對比[J]. 中國熱帶醫學, 2010, 10(6):744-745.
26. 劉文韜, 劉福坤.2002年版日本胃癌治療規范[J]. 中華胃腸外科雜志, 2003, 6(2):131-132.
27. Harrison LE, Karpeh MS, Brennan MF.Total gastrectomy is not necessary for proximal gastric cancer[J]. Surgery, 1998, 123(2):127-130.
28. Mann NS, Rachut E.Carcinoma of gastric stump causing afferent loop obstruction and acute pancreatitis[J]. Hepatogastroenterology, 2004, 51(55):184-185.

CHINESE JOURNAL OF BASES AND CLINICS IN GENERAL SURGERY

A Comparison Study of Total Gastrectomy Versus Proximal Gastrectomy for Advanced Esophagogastric Junction Cancer

Abstract Full text Figures/Tables Video References Cited by

Previous Article

Next Article

Format

Content