The length of proximal margin does not influence the prognosis of Siewert type II/III adenocarcinoma of esophagogastric junction after transhiatal curative gastrectomy.

Fan Feng,Shushang Liu,Yangzi Tian,Zhen Liu,Hongwei Zhang,Gaozan Zheng,Daiming Fan,Xiao Lian,Man Guo,Guanghui Xu

doi:10.1186/s40064-016-2240-3

Fan Feng, Shushang Liu + Show 8 more

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https://doi.org/10.1186/s40064-016-2240-3

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Journal: SpringerPlus	Publication Date: May 11, 2016
Citations: 10	License type: CC BY 4.0

Affiliation: Air Force Medical University, Xijing Hospital

Abstract

BackgroundThe optimal length of proximal margin for Siewert type II/III adenocarcinoma of the esophagogastric junction (AEJ) is still need to be clarified. The aim of the present study was to investigate the appropriate length of proximal margin for Siewert type II/III AEJ through transhiatal approach.MethodsFrom September 2009 to December 2014, a total of 693 consecutive patients with Siewert type II/III AEJ were retrospectively analyzed. All patients received transhiatal R0 resection. The proximal margin length was measured immediately after resection. The prognostic value of proximal margin length on Siewert type II/III AEJ with transhiatal approach was analyzed.ResultsThere were 404 cases of Siewert type II AEJ (58.3 %) and 289 cases of Siewert type III AEJ (41.7 %). Total gastrectomy was performed in 526 patients (75.9 %), and proximal gastrectomy was performed in 167 patients (24.1 %). The median length of the gross proximal margin was 2.4 (range 0.1–5.0) cm. Lymph node metastasis was the only independent prognostic predictor for Siewert type II AEJ. Tumor size and lymph node metastasis were independent prognostic predictors for Siewert type III AEJ.ConclusionsFor Siewert type II/III AEJ with esophageal invasion of 3 cm or less, proximal margin length does not influence the prognosis of patients after transhiatal curative gastrectomy.

Highlights

The optimal length of proximal margin for Siewert type II/III adenocarcinoma of the esophagogastric junction (AEJ) is still need to be clarified
The results showed that tumor size, Borrmann type, tumor depth, lymph node metastasis, TNM stage, lymphatic–vascular invasion, neural invasion and intraoperative blood loss were risk factors for the prognosis of Siewert type II AEJ
The results showed that tumor size, lymph node metastasis, TNM stage, lymphatic–vascular invasion, neural invasion and intraoperative blood loss were risk factors for the prognosis of Siewert type II AEJ

Summary

Introduction

The optimal length of proximal margin for Siewert type II/III adenocarcinoma of the esophagogastric junction (AEJ) is still need to be clarified. The aim of the present study was to investigate the appropriate length of proximal margin for Siewert type II/III AEJ through transhiatal approach. Adenocarcinoma of the esophagogastric junction (AEJ) is defined as a tumor with an epicenter within the 5 cm proximal and distal of the esophagogastric junction (Keeney and Bauer 2006). AEJ is classified into three types by Siewert in 1998 (Siewert and Stein 1998). The current trend of surgical resection for Siewert type III AEJ was radical gastrectomy (Gertler et al 2011). The optimal surgical treatment for Siewert type II AEJ remains controversial. Two phase III clinical trials performed in Japan and Netherlands demonstrated that transthoracic approach could not improve the prognosis of patients with Siewert type II compared with transhiatal approach

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