[Analysis of the therapeutic efficacy of radical gastrectomy in Siewert type Ⅱ and Ⅲ adenocarcinoma of the esophagogastric junction].

OBJECTIVE: To conduct a retrospective analysis of clinicopathological data of patients with Siewert type Ⅱand Ⅲ adenocarcinoma of the esophagogastric junction (AEG), who underwent total gastrectomy (TG) or proximal gastrectomy (PG), to discuss the differences between the two groups in 3-year and 5-year survival rates, postoperative complications and so forth, and to provide theoretical and clinical basis for choosing an ideal surgical approach for patients with Siewert typeⅡ and ⅢAEG.

METHODS: The clinical data of 163 patients who underwent radical gastrectomy from January 2006 to December 2008 were analyzed retrospectively. Among them, 85 patients received total gastrectomy (group TG) and 78 patients received proximal gastrectomy (group PG). The 3-year and 5-year survival rates, and postoperative complication rate and mortality rate in the two groups were followed up and compared.

RESULTS: The 3-year and 5-year survival rates of the group TG were 71.4% and 47.6%, and those of the group PG were 56.6% and 34.7%, showing a statistically significant difference (χ(2)=4.67, P=0.031;χ(2)=5.17, P=0.023). The postoperative complication rate and mortality rate of the group TG were 12.9% and 4.7% and those of the group PG were 19.2% and 2.6%, with a nonsignificant difference between the two groups (P>0.05). The incidence of reflux esophagitis in the group TG was 1.2%, significantly lower than that of 7.7% in the group PG (P<0.05).

CONCLUSIONS: To improve the long-term therapeutic effects, total gastrectomy should be recommended for patients with Siewert type Ⅱ and Ⅲ AEG having high risk factors such as tumor size >3.0 cm, subserosal or serosal invasion, N3 lymph node metastasis and stage Ⅲ tumor. The postoperative complication rate and mortality rate should not be increased, and reflux esophagitis can be effectively avoided in the patients treated with total gastrectomy.