Short- and Long-Term Outcomes of the Minimal Proximal Resection Margin in Total Gastrectomy for Siewert II Adenocarcinoma of the Esophagogastric Junction.

Abstract

This study aimed to investigate the feasibility of the minimal proximal resection margin (PRM) in total gastrectomy (TG) for Siewert II adenocarcinoma of the esophagogastric junction (AEG). This study finally included 178 Siewert II advanced AEG patients who underwent TG from January 2017 to September 2020. According to the PRM length, patients were divided into 20-25mm group and 30-35mm group. Intraoperative, short-, and long-term postoperative outcomes were compared between two groups. The PRM of the 20-25mm group had significantly less operation time compared with the PRM of the 30-35mm group (P < .001), but the amount of blood loss, management of the diaphragmatic crura, and the incidence of positive resection margin were not significantly different between two groups (P > .05). In short-term postoperative outcomes, first gas-passing time, gastric-tube removal time, start time of diet, hospitalization, postoperative complications, and body weight loss were similar between two groups (P > .05). During the follow-up, the 3-year overall survival rates and the recurrence rates were not significantly different between the PRM of 20-25mm and 30-35mm groups (81.2% vs 83.5%, P = .695; 18.8% vs 15.5%, P = .812, respectively). With less operation time and more preserved esophagus, the minimal PRM length of 20-25mm could be an appropriate option in TG for patients with Siewert II advanced AEG.