Proximal Gastrectomy versus Total Gastrectomy for Siewert Type II Adenocarcinoma of the Esophagogastric Junction: A Comprehensive Analysis of Data from the SEER Registry

Zhu, Keke; Xu, Yingying; Fu, Jiaxin; Mohamud, Farah Abdidahir; Duan, Zongkui; Tan, Siyuan; Zhao, Zhibin; Chen, Ping; Zong, Liang

doi:10.1155/2019/9637972

Cited by 26 publications

(26 citation statements)

References 26 publications

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“…Recently, Yura [ 15 ] studied 202 cases and revealed a metastasis rate of 0.99% for lymph node 4d, 0.006% for lymph node 12a, and 0% for lymph nodes 5 and 6 in T2–3 AEG. Kaixuan Zhu [ 16 ] et al analysed the Surveillance, Epidemiology and End Results database, and among 1584 patients treated with PG and 633 patients treated with TG, they found no difference in the 5-year overall survival rate, but PG resulted in better long-term survival in patients over 70 years of age. In this study, most of the patients had disease in a middle stage, including 14 patients with stage IIIA disease; these patients were followed up for 24 months, and 3 died from tumour recurrence.…”

Section: Discussionmentioning

confidence: 99%

Semi-embedded valve anastomosis a new anti-reflux anastomotic method after proximal gastrectomy for adenocarcinoma of the oesophagogastric junction

Wang

et al. 2020

BMC Surg

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Background There is a high probability of gastroesophageal reflux after laparoscopic proximal gastrectomy for adenocarcinoma of the oesophagogastric junction (AEG). Various anti-reflux anastomotic methods are emerging in clinical practice; however, none of them have been widely accepted. We have innovated a new type of anti-reflux anastomotic method, named semi-embedded valve anastomosis. The aim of this study was to explore the feasibility and anti-reflux effect of the new anastomotic method. Methods The clinical data of 28 patients with Siewert II AEG who were treated by semi-embedded valve anastomosis were collected. The key point of the operation is to reconstruct a simulated valve and form an anti-reflux barrier similar to the physiological mechanism. The gastroesophageal reflux disease questionnaire (GerdQ) and classification of gastroesophageal reflux under electron microscopy were used to evaluate gastroesophageal reflux after the operation. Results The mean operative duration was 164.3 ± 19.0 min, the median intraoperative haemorrhage volume was 65 ml, the average number of lymph nodes dissected was 23 ± 2.6, the time for valve construction was 15.8 ± 3.2 min, the time for anastomotic reconstruction was 35.4 ± 4.8 min, the median time to first flatus was 3 d, and the median hospitalization duration was 12 d. There was one case of postoperative anastomotic stenosis. The GerdQ score [median (range)] was as follows: 2 (0–6), preoperation; 0 (0–8), 1 month postoperation; 2 (0–12), 3 months postoperation; and 3 (0–12), 6 months postoperation. The Wilcoxon signed-rank sum test was carried out at different times after the operation and the day before the operation, and the differences were not significant. There was one case of grade B gastroesophageal reflux according to the Los Angeles classification system among the gastrofibroscopic re-examination reports of 28 cases. Conclusion Semi-embedded valve anastomosis is safe and feasible after proximal gastrectomy for Siewert II AEG and has good anti-reflux effects.

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Section: Discussionmentioning

confidence: 99%

Semi-embedded valve anastomosis a new anti-reflux anastomotic method after proximal gastrectomy for adenocarcinoma of the oesophagogastric junction

Wang

et al. 2020

BMC Surg

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“…Recently, Yura [15] studied 202 cases and revealed a metastasis rate of 0.99% for lymph node 4d, 0.006% for lymph node 12a, and 0% for lymph nodes 5 and 6 in T2-3 AEG. Kaixuan Zhu [16] et al analysed the Surveillance, Epidemiology and End Results (SEER) database, and among 1584 patients treated with PG and 633 patients treated with TG, they found no difference in the 5-year overall survival (OS) rate, but PG resulted in better long-term survival in patients over 70 years of age. In this study, most of the patients had disease in a middle stage, including 14 patients with stage A disease; these patients were followed up for 24 months, and 3 died from tumour recurrence.…”

Section: Discussionmentioning

confidence: 99%

Semi-embedded Valve Anastomosis A new anti-reflux anastomotic method after proximal gastrectomy for adenocarcinoma of the oesophagogastric junction

Wang

et al. 2020

Preprint

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Background There is a high probability of gastroesophageal reflux after laparoscopic proximal gastrectomy for Siewert Ⅱ AEG. Various anti-reflux anastomotic methods are emerging in clinical practice; however, none of them have been widely accepted. We have innovated a new type of anti-reflux anastomotic method, named semi-embedded valve anastomosis. The aim of this study was to explore the feasibility and anti-reflux effect of the new anastomotic method. Methods The clinical data of 28 patients with Siewert II AEG who were treated by semi-embedded valve anastomosis were collected. The key point of the operation is to reconstruct a simulated valve and form an anti-reflux barrier similar to the physiological mechanism. The GerdQ gastroesophageal reflux questionnaire and classification of gastroesophageal reflux under electron microscopy were used to evaluate gastroesophageal reflux after the operation. Results The mean operative duration was 164.3±19.0 min, the median intraoperative haemorrhage volume was 65 ml, the average number of lymph nodes dissected was 23±2.6, the time for valve construction was 15.8±3.2 min, the time for anastomotic reconstruction was 35.4±4.8 min, the median time to first flatus was 3 d, and the median hospitalization duration was 12 d. There was one case of postoperative anastomotic stenosis. The GerdQ score [median (range)] was as follows: 2 (0-6), preoperation; 0 (0-8), 1 month postoperation; 2 (0-12), 3 months postoperation; and 3 (0-12), 6 months postoperation. The Wilcoxon signed-rank sum test was carried out at different times after the operation and the day before the operation, and the differences were not significant (P<0.05). There was one case of grade B gastroesophageal reflux according to the LA classification system among the gastrofibroscopic re-examination reports of 28 cases. Conclusion Semi-embedded valve anastomosis is safe and feasible after proximal gastrectomy for Siewert II AEG and has good anti-reflux effects.

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“…In summary, LNM in patients with Siewert II/III AEG was mainly associated with the parameters infiltration depth, gross type and intravascular cancer embolus. For Siewert II AEG patients, it is reasonable to excise both celiac and mediastinal lymph nodes, notably for No.1, 2,3,4,7,11,110 and No.111 lymph nodes. However, pyloric lymph nodes did not require dissection.…”

Section: Discussionmentioning

confidence: 99%

“…In recent years, the incidence and mortality of AEG have increased [2][3][4]. This region is a special anatomical location, involving complex operation and multiple lymphatic drainage approaches [5].…”

Section: Introductionmentioning

confidence: 99%

Assessment of risk factors of lymph node metastasis and prognosis of Siewert II/III adenocarcinoma of esophagogastric junction: a retrospective study

Zheng¹,

Zhang²,

Xu³

et al. 2020

Preprint

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Background Adenocarcinoma of esophagogastric junction (AEG) has a high incidence, while the extent of lymph node dissection (LND) and prognosis are still controversial. The present study aimed to explore the risk factors of lymph node metastasis (LNM) and prognosis in Siewert II/III AEG patients. Methods A total of 134 patients who underwent surgical operation between July 2013 and December 2019 at the Beijing Friendship Hospital were retrospectively reviewed. The patients were followed up until January 2020. The data were analyzed using logistic regression. Survival analyses were performed using Cox regression. Results Multivariate analysis revealed that the parameters infiltration depth (OR=4.341, 95%CI: 2.498-7.545, P=0.000), gross type (OR=3.626, 95% CI: 1.425-9.228, P=0.007) and intravascular cancer embolus (OR=2.888, 95%CI: 1.106-7.544, P=0.030) correlated with LNM. For all patients, the lymph nodes No. 1, 2, 3, 4, 7, 11 indicated higher lymph node metastatic rate in the abdominal cavity. However, No.5 and No. 6 indicated different tendency, which was higher in Siewert III AEG and lower in Siewert II AEG patients. Mediastinal LNM of Siewert II AEG mainly occurred in No. 110 and No. 111 cases corresponding to 7.1 and 3%, respectively, compared with those noted in Siewert III AEG patients. The 3-year overall survival analysis revealed that LNM ( P= 0.046) and chemotherapy ( P= 0.007) exhibited significant differences. Conclusion The infiltration depth, gross type and intravascular cancer embolus were independent risk factors of LNM. For Siewert II AEG patients, it is reasonable to remove both celiac and mediastinal lymph nodes. This was noted notably for No.1, 2, 3, 4, 7, 11, 110 and No.111. For No.5 and No.6 lymph nodes dissection was not required. For Siewert III AEG patients, mediastinal LND was not required. However, it was necessary to perform pyloric lymphadenectomy, which was performed for No.5 and No.6 lymph nodes. In addition, patients with LNM exhibited worse long-term prognosis. The data indicated that perioperative chemotherapy could improve the prognosis of AEG patients.

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Proximal Gastrectomy versus Total Gastrectomy for Siewert Type II Adenocarcinoma of the Esophagogastric Junction: A Comprehensive Analysis of Data from the SEER Registry

Cited by 26 publications

References 26 publications

Semi-embedded valve anastomosis a new anti-reflux anastomotic method after proximal gastrectomy for adenocarcinoma of the oesophagogastric junction

Semi-embedded valve anastomosis a new anti-reflux anastomotic method after proximal gastrectomy for adenocarcinoma of the oesophagogastric junction

Semi-embedded Valve Anastomosis A new anti-reflux anastomotic method after proximal gastrectomy for adenocarcinoma of the oesophagogastric junction

Assessment of risk factors of lymph node metastasis and prognosis of Siewert II/III adenocarcinoma of esophagogastric junction: a retrospective study

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