Surgical approaches and prognostic analysis of Siewert type I adenocarcinoma of the esophagogastric junction

Abstract

Objective To investigate rational surgical approaches for Siewert type I adenocarcinoma of the esophagogastric junction （ AEG）, and analyze the prognostic factors. Methods The clinical data of 103 patients with Siewert type I AEG who were admitted to the Renji Hospital from January 2005 to December 2009 were retro- spectively analyzed. All patients were divided into transthoracic approach group （61 patients） and thoracoabdominal approach group （42 patients）. The incidences of numbers of lymph node dissected and postoperative complications of the 2 groups were compared using the chi-square test, Fisher exact probability or the t test. The survival curve was drawn by the Kaplan-Meier method and the survival was analyzed using the Log-rank test. Prognostic factors were analyzed using the one-way analysis of variance and Cox regression model. Results No perioperative death was observed in the 2 groups. There were significant differences in the number of lymph node dissected and number of metastatic lymph node between the 2 groups （t =2. 18, 2.29, P 〈 0.05 ）. There was no significant difference in splenic injury between the 2 groups （ P 〉 0.05 ）. There were no significant differences in postoperative bleed- ing, anastomotic fistula and stricture, esophagogastric reflux, pulmonary infection and osteomyelitis between the 2 groups （X2 =0.07, 0.94, 0.22, 1.41, 0.17, P〉0 up. The mean postoperative survival time was 26 months. 05）. Of the 103 patients, 97 （ 94.2% ） were followed The median survival time was 26 months, and the 3-year survival rate was 35.9%. The 3-year survival rates of transthoracic approach group and thoracoabdominal approach group were 32.8% and 40.2% , with no significant difference between the 2 groups （X2 = 0.37, P 〉 0, 05 ）. The results of univariate analysis showed that radical or palliative resection, TNM stage, lymph node metastasis stage, tumor diameter and metastasis rate, degree of radical resection were independent factors influencing the prognosis of patients with Siewert type I AEG （X2 =21.07, 26.04, 22.42, 6.26, 32.20, 20.80, P 〈0.05）. The results of muhivariate analysis showed that degree of TNM stage, lymph node metastasis rate and radical resection were independent factors influencing the prognosis of patients （ Wald = 12. 01, 8. 75, 10. 03, P 〈 0.05 ）. Conclusions Thoracoabdominal approach is a reasonable selection for patients with Siewert type I AEG. Degree of TNM stage, lymph node metastasis rate and radical resection were independent risk factors influencing the prognosis of patients. Key words: Adenocarcinoma of the esophagogastric junction ; Siewert type I ; Surgical approach ; Prognostic factors