A Comparison Study of Total Gastrectomy Versus Proximal Gastrectomy for Advanced Esophagogastric Junction Cancer_CHINESE JOURNAL OF BASES AND CLINICS IN GENERAL SURGERY

Authors：

 YULiang ,  LUCheng-yu , YUANAi-hua , CHENWei , ZHANGYi-fan , WUAn-wei

Department of General Surgery, Affiliated Nanjing Hospital/The First Hospital of Nanjing City, Nanjing Medical University, Nanjing 210006, Jiangsu Province, China;

Corresponding author：

LUCheng-yu, Email: lcy_1234@aliyun.com

Keywords：

Esophagogastric junction cancer; Total gastrectomy; Proximal gastrectomy; Survival rate

DOI：

10.7507/1007-9424.20140270

Video：

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Objective To evaluate the effect of total gastrectomy (TG) and proximal gastrectomy (PG) for the treatment of advanced esophagogastric junction cancer. Methods Clinical data of 273 cases of advanced esophagogastric junction cancer who underwent TG and PG in our hospital from Jan. 2004 to Dec. 2010 were reviewed for retrospective analysis. Operation related indexes, 3-year cumulative survival rate, and 5-year cumulative survival rate were compared and evaluated. Results There was no significant difference between TG group and PG group in intraoperative blood loss, operation time, and hospital stay(P > 0.05), but the number of dissected lymph nodes in TG group was obviously more than those of PG group, and the difference was statistically significant(P=0.000). The postoperative complication rates were 10.3%(12/117)in TG group and 21.8%(34/156) in PG group respectively, which was lower in TG group(χ²=6.353, P < 0.05). The 3-year and 5-year cumulative survival rates of TG group were 58.9% and 34.2%, of PG group were 43.4% and 23.6% respectively, and the 3-year and 5-year cumulative survival rates were all lower in PG group(χ²=5.894, P < 0.05;χ²=5.582, P < 0.05). For patients in stage pT4, pN2, and TNMⅢ, whose tumor size were bigger than 3.0 cm, and patients who had accept chemotherapy, the 3-and 5-year cumulative survival rates of TG group were significantly higher than those of PG group(P < 0.05). However, for patients in stage pT2, pT3, pN0, pN1, pN3, TNMⅠ, TNMⅡ, TNMⅣ, whose tumor size were smaller than 3.0 cm, who had not accept chemotherapy, and patients of any pathological type, there was no statistically significant difference between the 2 groups in 3-year and 5-year cumulative survival rates(P > 0.05). Conclusion For the patients who suffered from advanced esophagogastric junction cancer, TG can improve long-term survival rate, and it can significantly reduce the incidence of postoperative complications and improve postoperative quality of life.

Citation： YULiang, LUCheng-yu, YUANAi-hua, CHENWei, ZHANGYi-fan, WUAn-wei. A Comparison Study of Total Gastrectomy Versus Proximal Gastrectomy for Advanced Esophagogastric Junction Cancer. CHINESE JOURNAL OF BASES AND CLINICS IN GENERAL SURGERY, 2014, 21(9): 1124-1129. doi: 10.7507/1007-9424.20140270 Copy

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2.	Kim DY, Joo JK, Park YK, et al.Predictors of long-term survival in node-positive gastric carcinoma patients with curative resection[J]. Langenbecks Arch Surg, 2007, 392(2):131-134.
3.	谢洪虎, 吕成余, 陈维, 等.958例胃癌临床病理资料分析[J]. 中国普外基础与临床杂志, 2011, 18(2):153-158.
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5.	Gronnier C, Piessen G, Mariette C.Diagnosis and treatment of non-metastatic esophagogastric junction adenocarcinoma:what are the current options?[J]. J Visc Surg, 2012, 149(1):e23-e33.
6.	王家镔, 黄昌明, 卢辉山, 等.联合脾切除治疗胃上部癌No.10淋巴结转移的疗效[J]. 中华胃肠外科杂志, 2009, 12(2):121-125.
7.	Matsuda T, Takeuchi H, Tsuwano S, et al.Optimal surgical management for esophagogastric junction carcinoma[J]. Gen Thorac Cardiovasc Surg, 2014,[Epub ahead of print].
8.	Wen L, Chen XZ, Wu B, et al.Total vs. proximal gastrectomy for proximal gastric cancer:a systematic review and meta-analysis[J]. Hepatogastroenterology, 2012, 59(114):633-640.
9.	王云, 蒲长春, 吴敬章, 等.全胃切除与近侧胃切除治疗胃底贲门部癌术后生存状态对比分析[J]. 中国普外基础与临床杂志, 2013, 20(11):1272-1278.
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11.	Washington K.7th edition of the AJCC cancer staging manual:stomach[J]. Ann Surg Oncol, 2010, 17(12):3077-3079.
12.	Richter JE.Gastroesophageal reflux disease treatment:side effects and complications of fundoplication[J]. Clin Gastroenterol Hepatol, 2013, 11(5):465-471.
13.	Hoshikawa T, Denno R, Ura H, et al.Proximal gastrectomy and jejunal pouch interposition:evaluation of postoperative symptoms and gastrointestinal hormone secretion[J]. Oncol Rep, 2001, 8(6):1293-1299.
14.	沈朝勇, 杨宏鑫, 张波, 等.近端胃切除术与全胃切除术对食管胃结合部腺癌患者生活质量的影响[J]. 中国普外基础与临床杂志, 2013, 20(12):1381-1385.
15.	朱德祥, 秦震声, 于仁.近端胃切除及全胃切除术治疗贲门癌的比较研究[J]. 现代生物医学进展, 2010, 10(8):1520-1521.
16.	Hölscher AH, Voit H, Buttermann G, et al.Function of the intrathoracic stomach as esophageal replacement[J]. World J Surg, 1988, 12(6):835-844.
17.	Zarate N, Mearin F, Wang XY, et al.Severe idiopathic gastroparesis due to neuronal and interstitial cells of Cajal degeneration:pathological findings and management[J]. Gut, 2003, 52(7):966-970.
18.	An JY, Youn HG, Choi MG, et al.The difficult choice between total and proximal gastrectomy in proximal early gastric cancer[J]. Am J Surg, 2008, 196(4):587-591.
19.	Papachristou DN, Fortner JG.Adenocarcinoma of the gastric cardia.The choice of gastrectomy[J]. Ann Surg, 1980, 192(1):58-64.
20.	王劲, 张隆陶.贲门癌的全胃切除术疗效分析[J]. 中国临床研究, 2013, 26(8):793-794.
21.	黄昌明, 张祥福, 卢辉山, 等.全胃切除术治疗胃底贲门癌的远期疗效[J]. 中华外科杂志, 2003, 41(10):729-732.
22.	Takeshita K, Ashikawa T, Tani M, et al.Clinicopathologic features of gastric cancer infiltrating the lower esophagus[J]. World J Surg, 1994, 18(3):428-432.
23.	潘常青, 薛延庆, 彭志海.进展期胃近侧癌的淋巴结转移和手术治疗[J]. 中国实用外科杂志, 2000, 20(10):608-610.
24.	官国先, 张祥福, 卢辉山, 等.根治性全胃切除术治疗进展期贲门癌的疗效评价[J]. 中华普通外科杂志, 2006, 21(8):564-566.
25.	王文睿, 朱立桓, 杨胜生, 等.全胃切除与近端胃切除治疗贲门癌的疗效对比[J]. 中国热带医学, 2010, 10(6):744-745.
26.	刘文韬, 刘福坤.2002年版日本胃癌治疗规范[J]. 中华胃肠外科杂志, 2003, 6(2):131-132.
27.	Harrison LE, Karpeh MS, Brennan MF.Total gastrectomy is not necessary for proximal gastric cancer[J]. Surgery, 1998, 123(2):127-130.
28.	Mann NS, Rachut E.Carcinoma of gastric stump causing afferent loop obstruction and acute pancreatitis[J]. Hepatogastroenterology, 2004, 51(55):184-185.

1. Krejs GJ.Gastric cancer:epidemiology and risk factors[J]. Dig Dis, 2010, 28(4-5):600-603.
2. Kim DY, Joo JK, Park YK, et al.Predictors of long-term survival in node-positive gastric carcinoma patients with curative resection[J]. Langenbecks Arch Surg, 2007, 392(2):131-134.
3. 谢洪虎, 吕成余, 陈维, 等.958例胃癌临床病理资料分析[J]. 中国普外基础与临床杂志, 2011, 18(2):153-158.
4. Siegel R, Naishadham D, Jemal A.Cancer statistics, 2013[J]. CA Cancer J Clin, 2013, 63(1):11-30.
5. Gronnier C, Piessen G, Mariette C.Diagnosis and treatment of non-metastatic esophagogastric junction adenocarcinoma:what are the current options?[J]. J Visc Surg, 2012, 149(1):e23-e33.
6. 王家镔, 黄昌明, 卢辉山, 等.联合脾切除治疗胃上部癌No.10淋巴结转移的疗效[J]. 中华胃肠外科杂志, 2009, 12(2):121-125.
7. Matsuda T, Takeuchi H, Tsuwano S, et al.Optimal surgical management for esophagogastric junction carcinoma[J]. Gen Thorac Cardiovasc Surg, 2014,[Epub ahead of print].
8. Wen L, Chen XZ, Wu B, et al.Total vs. proximal gastrectomy for proximal gastric cancer:a systematic review and meta-analysis[J]. Hepatogastroenterology, 2012, 59(114):633-640.
9. 王云, 蒲长春, 吴敬章, 等.全胃切除与近侧胃切除治疗胃底贲门部癌术后生存状态对比分析[J]. 中国普外基础与临床杂志, 2013, 20(11):1272-1278.
10. Siewert JR, Stein HJ, Feith M.Adenocarcinoma of the esophagogastric junction[J]. Scand J Surg, 2006, 95(4):260-269.
11. Washington K.7th edition of the AJCC cancer staging manual:stomach[J]. Ann Surg Oncol, 2010, 17(12):3077-3079.
12. Richter JE.Gastroesophageal reflux disease treatment:side effects and complications of fundoplication[J]. Clin Gastroenterol Hepatol, 2013, 11(5):465-471.
13. Hoshikawa T, Denno R, Ura H, et al.Proximal gastrectomy and jejunal pouch interposition:evaluation of postoperative symptoms and gastrointestinal hormone secretion[J]. Oncol Rep, 2001, 8(6):1293-1299.
14. 沈朝勇, 杨宏鑫, 张波, 等.近端胃切除术与全胃切除术对食管胃结合部腺癌患者生活质量的影响[J]. 中国普外基础与临床杂志, 2013, 20(12):1381-1385.
15. 朱德祥, 秦震声, 于仁.近端胃切除及全胃切除术治疗贲门癌的比较研究[J]. 现代生物医学进展, 2010, 10(8):1520-1521.
16. Hölscher AH, Voit H, Buttermann G, et al.Function of the intrathoracic stomach as esophageal replacement[J]. World J Surg, 1988, 12(6):835-844.
17. Zarate N, Mearin F, Wang XY, et al.Severe idiopathic gastroparesis due to neuronal and interstitial cells of Cajal degeneration:pathological findings and management[J]. Gut, 2003, 52(7):966-970.
18. An JY, Youn HG, Choi MG, et al.The difficult choice between total and proximal gastrectomy in proximal early gastric cancer[J]. Am J Surg, 2008, 196(4):587-591.
19. Papachristou DN, Fortner JG.Adenocarcinoma of the gastric cardia.The choice of gastrectomy[J]. Ann Surg, 1980, 192(1):58-64.
20. 王劲, 张隆陶.贲门癌的全胃切除术疗效分析[J]. 中国临床研究, 2013, 26(8):793-794.
21. 黄昌明, 张祥福, 卢辉山, 等.全胃切除术治疗胃底贲门癌的远期疗效[J]. 中华外科杂志, 2003, 41(10):729-732.
22. Takeshita K, Ashikawa T, Tani M, et al.Clinicopathologic features of gastric cancer infiltrating the lower esophagus[J]. World J Surg, 1994, 18(3):428-432.
23. 潘常青, 薛延庆, 彭志海.进展期胃近侧癌的淋巴结转移和手术治疗[J]. 中国实用外科杂志, 2000, 20(10):608-610.
24. 官国先, 张祥福, 卢辉山, 等.根治性全胃切除术治疗进展期贲门癌的疗效评价[J]. 中华普通外科杂志, 2006, 21(8):564-566.
25. 王文睿, 朱立桓, 杨胜生, 等.全胃切除与近端胃切除治疗贲门癌的疗效对比[J]. 中国热带医学, 2010, 10(6):744-745.
26. 刘文韬, 刘福坤.2002年版日本胃癌治疗规范[J]. 中华胃肠外科杂志, 2003, 6(2):131-132.
27. Harrison LE, Karpeh MS, Brennan MF.Total gastrectomy is not necessary for proximal gastric cancer[J]. Surgery, 1998, 123(2):127-130.
28. Mann NS, Rachut E.Carcinoma of gastric stump causing afferent loop obstruction and acute pancreatitis[J]. Hepatogastroenterology, 2004, 51(55):184-185.

CHINESE JOURNAL OF BASES AND CLINICS IN GENERAL SURGERY

A Comparison Study of Total Gastrectomy Versus Proximal Gastrectomy for Advanced Esophagogastric Junction Cancer

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