Objective To explore the risk factors of recurrence and metastasis in patients with Siewert Ⅱ and Ⅲ adenocarcinoma of esophagogastric junction (AEG) after radical gastrectomy. Methods A retrospective study was conducted to collect the clinical data of 146 patients with type Ⅱ and Ⅲ AEG who underwent radical gastrectomy from January 2010 to January 2013 in the Nanjing First Hospital of Nanjing Medical University. The factors affected the recurrence and metastasis of the patients after the radical gastrectomy were analyzed by the unconditional logistic regression analysis. Results The 146 AEG patients were followed up for 3–84 months, with the median follow-up time of 48 months. During the follow-up period, there were 59 cases suffered from recurrence and metastasis. The recurrence and metastasis time was 1–50 months after radical gastrectomy, with the median time of 17 months after radical gastrectomy. The results of multivariate logistic regression analysis showed that, the histological grade (OR=4.478, P=0.015), the number of positive lymph nodes (OR=2.886, P<0.001), and vascular invasion (OR=5.334, P=0.003) were independent risk factors for the recurrence and metastasis of AEG patients after radical gastrectomy. Patients with low tumor histological grade (G3+G4), a large number of positive lymph nodes, and vascular invasion were more likely to have recurrence and metastasis after radical gastrectomy. Conclusions The histological grade of tissue, number of positive lymph nodes, and vascular invasion are important factors in predicting the recurrence and metastasis of Siewert Ⅱ/Ⅲ AEG patients after radical gastrectomy.
ObjectiveThe main objective of this study is to systematically evaluate the efficacy and safety of proximal gastrectomy and total gastrectomy in the treatment of Siewert Ⅱ and Ⅲ adenocarcinoma of the esophagogastric junction. MethodsThis study conducted a meta-analysis using Review Manager 5.4 software to compare the efficacy and safety of proximal gastrectomy and total gastrectomy in the treatment of Siewert Ⅱ/Ⅲ adenocarcinoma of the esophagogastric junction. Databases including PubMed, The Cochrane Library, Web of Science, EMbase, CNKI, Wanfang Data, and VIP were searched for relevant literature published through March 2023. ResultsThis study included a total of 23 articles, among which 16 were retrospective studies, 5 were prospective studies, and 2 were RCT. In total, 2826 patients, 1389 patients underwent proximal gastrectomy and 1437 patients underwent total gastrectomy. Meta-analysis showed that proximal gastrectomy had less intraoperative bleeding than total gastrectomy [MD=-19.85, 95% CI (-37.20, -2.51), P=0.02] and shorter postoperative hospital stay. Total gastrectomy had a higher number of lymph node dissections than proximal gastrectomy [MD=-6.20, 95% CI (-7.68, -4.71), P<0.00001] and a lower incidence of reflux esophagitis [MD=3.02, 95% CI (1.24, 7.34), P=0.01]. In contrast, there was no statistically significant difference between the two procedures in terms of operative time, postoperative OS (1-year OS, 3-year OS, 5-year OS) and total postoperative complications (P>0.05). ConclusionProximal gastrectomy had an advantage in terms of intraoperative bleeding and postoperative length of stay, whereas total gastrectomy had an advantage in terms of number of lymph nodes cleared and incidence of reflux esophagitis, with no significant difference in long-term survival between the two procedures.