Prognostic Significance of the Proximal Margin for Esophagogastric Junction Adenocarcinoma with Type II and III Tumors after Surgery

Abstract

Background: The incidence of Esophagogastric Junction Adenocarcinoma (EJA) has increased in recent years, with surgical resection the main choice of treatment. The optimal length of the proximal margin for EJA is still under debate, and the impact of EJA survival and recurrence remains unclear. The aim of the present study was to investigate the influence of the optimal length of the proximal margin on EJA. Methods: From January 2011 to December 2015, 131 patients who had EJA with type II tumors were included and retrospectively analyzed. All patients underwent radical R0 resection. The proximal margin was measured promptly after resection, and the frozen-section pathological examination was negative for the margin. Results: There were 3 cases of Siewert type I EJA (2.9%), 75 cases of Siewert type II EJA (57.9%), and 53 cases (40.1%) of Siewert type III EJA. The median number of lymph nodes examined was 19 (range: 1-41), and the median number of positive lymph nodes was 2 (range: 0–18). Sixty-three patients underwent total gastrectomy (48.1%), and 68 underwent proximal gastrectomy (51.9%). The median follow-up time was 57.3 months: (range 1.9–174.1); 34 patients (26%) relapsed and 74 (56.5%) died. The 5-year overall survival rate of type II tumor patients was 68.2%, and that of type III tumor patients was 38.5% (P=0.02). For patients with a proximal margin <2cm, the median recurrence time was 41.6 months, whereas it was for 42.8 months for patients with proximal margin >2cm (log–rank: 0.496). Our data analysis found that a proximal margin length of 2cm was a prognostic variable for type II and type III tumors. Conclusions: There are a number of factors associated with recurrence and overall survival at 5 years for patients who have EJA with type II and type III tumors, and a proximal margin >2cm may indicate better prognosis.