Abstract： Objective To compare clinical outcomes and postoperative quality of life （QOL） of difference surgical strategies for patients with esophagogastric junction （EGJ） cancer， and investigate the best surgical strategy. Methods A total of 148 patients with EGJ cancer underwent surgical treatment in Xuzhou First People’s Hospital from July 2007 to October 2011. There were 111 male patients and 37 female patients with an average age of 64 （47-77）years. All the patients were divided into 3 groups according to different surgical strategies for them based on their respective preoperative assessment and tumor invasion degree. In group A， 81 patients underwent proximal subtotal gastrectomy and subaortic gastroesophageal anastomosis. In group B， 20 patients underwent total gastrectomy and esophagojejunostomy. In group C， 47 patients underwent proximal subtotal gastrectomy and jejunal interposition. Postoperative mortality and morbidity were compared among the three groups. Cancer metastasis rate and 1-year survival rate were also compared among the three groups. QOL questionnaire （EORTC QLQ C-30 and tumor specific module QLQ-OES24） was used to evaluate patients’ QOL during follow-up. Results There was no statistical difference in postoperative morbidity （P=0.762）and mortality （P=0.650）among the three groups. There was no statistical difference in cancer metastasis rate at 1 year after surgery among the three groups （P=0.983）. One-year survival rate was 100% in all the three groups. At 1 year after surgery， physical functioning score （P=0.037，0.000） and global health score （P=0.035，0.006） of group A and group C were significantly higher than those of group B， and there was no statistical difference in physical functioning score and global health score between group A and group C （P＞0.05）. Emotional function score of group B was significantly lower than that of group C （P=0.015）. Fatigue score （P=0.040，0.006）， anorexia（P=0.045，0.025）， nausea and vomiting symptom score （P=0.033，0.048） of group A and group C were significantly lower than those of group B. Pain score of group A was significantly lower than that of group C （P=0.009）. Insomnia score of group A was significantly higher than that of group C （P=0.028）. Reflux score of group A was significantly higher than that of group B and group C （P=0.025，P=0.021）. Conclusion Postoperative QOL in patients with EGJ cancer who undergo total gastrectomy is comparatively unsatisfactory. Proximal subtotal gastrectomy and jejunal interposition can significantly improve postoperative QOL. Postoperative QOL evaluation is helpful to choose better surgical strategies for patients with EGJ cancer.
ObjectiveTo investigate the anti-reflux effect of the conventional esophagogastrostomy with modified Nissen fundoplication in the carcinoma of esophagogastric junction. MethodsSixty patients with carcinoma of esophagogastric junction were divided into two groups including conventional esophagogastrostomy (a group A) and modified fundopication added conventional anastomosis (a group B) in our hospital from November 2011 through November 2013. There were 45 males and 14 females at age of 61.6 (40-73) years. Thirty-nine esophagectomized patients were invited for operative follow-up including reflux disease questionnaire (RDQ) of esophageal reflux symptoms and endoscopy from postoperative 6 months to 1 year. The operative mortality and incidence of complication were obtained from hospital record. ResultsThere was no statistical difference in the operative mortality and incidence of complication between the group A and the group B (P>0.05). The scores of esophageal reflux symptoms and incidence of score of RDQ>12 in the group B were significantly lower than those in the group A (P < 0.05). Anastomotic stenosis was not observed in the two groups by endoscopy. Although no difference in the incidence of reflux esophagitis was found between the two groups (P=0.122), the score of reflux esophagitis in the group B was evidently declined compared with that in the group A (P=0.032). ConclusionModified Nissen fundoplication following conventional esophagogastrostomy in carcinoma of esophagogastic junction may be conveniently performed with effect of reducing gastroesophageal reflux. It's long-term effect of anti-reflux need to be observed in future.
Objective To analyze influencing factors and construction of a nomogram predictive model for anastomotic leak after radical esophageal and gastroesophageal junction carcinoma. Methods The patients who underwent radical esophagectomy at Jinling Hospital affiliated to Nanjing University School of Medicine from January 2018 to June 2020 were selected. After screening for related variables using SPSS univariate and multivariate logistic regression analysis, the "nomogram" was used to predict the risk of anastomotic leak based on R language. The predicted effects were verified by the receiver operating characteristic (ROC) curves. Results A total of 468 patients with esophageal carcinoma were collected, including 354 (75.64%) males and 114 (24.35%) females with a mean age of 62.8±7.2 years. The tumor was mainly located in the middle or lower stage; 51 (10.90% ) patients had postoperative anastomotic leak. In univariate logistic regression analysis, age, BMI, tumor location, preoperative albumin, diabetes mellitus, anastomosis mode, anastomosis site, and CRP might be associated with anastomotic leak (P＜0.05). The above data suggested by multivariate logistic regression analysis illustrate that age, BMI, tumor location, diabetes mellitus, anastomosis mode, and CRP were independent risks of anastomotic leak (P＜0.05). The nomogram was constructed according to the results of multivariate logistic regression analysis. The area under the curve (AUC) of ROC curve was 0.803 showing that the actual observations agree well with the predicted results. In addition, the decision curve analysis concluded that the newly established nomogram was significant for clinical decision-making. Conclusion The predictive model of anastomotic leak after radical esophageal and gastroesophageal junction carcinoma has a good predictive effect and is critical for guiding clinical observation, early screening and prevention.