Feasibility of laparoscopic total gastrectomy for advanced Siewert type Ⅱ and type Ⅲ esophagogastric junction carcinoma: A propensity score-matched case-control study

Abstract

This study aims to compare laparoscopic total gastrectomy (LTG) with open total gastrectomy (OTG) for treating advanced Siewert type Ⅱ and type Ⅲ adenocarcinoma of esophagogastric junction (AEG). The data for this study included 872 patients with advanced Siewert type Ⅱ and type Ⅲ AEG who were candidates for undergoing total gastrectomy from January 2012 to December 2017 in Gastrointestinal Surgery Department of the First Hospital of Jilin University. After screening all the patients' data, 722 patients underwent the propensity score match (PSM) and out of them, 685 patients were selected and grouped into LTG group (n=468) and OTG group (n=217). Observing the patients' C reactive protein (CRP) level (p<0.001) and pain score on postoperative day (POD) 1 (p<0.001) and POD2 (p<0.001) showed that the patients in LTG group were less stressed than those in OTG group. Moreover, patients who underwent LTG were able to sooner take liquid food (p<0.001), get off beds to walk (p<0.001), restore bowel function (p<0.001), and had shorter postoperative stay (p<0.001). On the other hand, these two groups showed no significant difference regarding postoperative complication rate (p=0.19). The median survival for the LTG and OTG groups was 56 months and 47 months, respectively, and the 5-year overall survival (OS) was 40% and 29.1%, respectively. The LTG group obtained better OS (p<0.01), with hazard ratio of 0.69 (LTG vs. OTG, 95% confidence interval, 0.52 to 0.91). Moreover, the hazard ratio of Siewert type Ⅱ was 0.79 (95% confidence interval, 0.46 to 1.12) and that of Siewert type Ⅲ was 1.16 (95% confidence interval, 0.78 to 1.54). It can thus be seen that LTG is a safe and effective method for treating patients with advanced Siewert type Ⅱ and type Ⅲ AEG and patients with Siewert type Ⅱ AEG may benefit more from LTG in the long term.