AUTHOR=Zhao Baoyu , Zhang Zhenzhan , Mo Debin , Lu Yiming , Hu Yanfeng , Yu Jiang , Liu Hao , Li Guoxin 

TITLE=Optimal Extent of Transhiatal Gastrectomy and Lymphadenectomy for the Stomach-Predominant Adenocarcinoma of Esophagogastric Junction: Retrospective Single-Institution Study in China

JOURNAL=Frontiers in Oncology

VOLUME=8

YEAR=2019

URL=https://www.frontiersin.org/journals/oncology/articles/10.3389/fonc.2018.00639

DOI=10.3389/fonc.2018.00639

ISSN=2234-943X

ABSTRACT=<p><bold>Background:</bold> The optimal extent of gastrectomy and lymphadenectomy for esophagogastric junction (EGJ) cancer is controversial. Our study aimed to compare the long-term survival of transhiatal proximal gastrectomy with extended periproximal lymphadenectomy (THPG with EPL) and transhiatal total gastrectomy with complete perigastric lymphadenectomy (THTG with CPL) for patients with the stomach-predominant EGJ cancer.</p><p><bold>Methods:</bold> Between January 2004, and August 2015, 306 patients with Siewert II tumors were divided into the THTG group (<italic>n</italic> = 148) and the THPG group (<italic>n</italic> = 158). Their long-term survival was compared according to Nishi's classification. The Kaplan–Meier method and Cox proportional hazards models were used for survival analysis.</p><p><bold>Results:</bold> There were no significant differences between the two groups in the distribution of age, gender, tumor size or Nishi's type (<italic>P</italic> &gt; 0.05). However, a significant difference was observed in terms of pathological tumor stage (<italic>P</italic> &lt; 0.05). The 5-year overall survival rates were 62.0% in the THPG group and 59.5% in the THTG group. The hazard ratio for death was 0.455 (95% CI, 0.337 to 0.613; log-rank <italic>P</italic> &lt; 0.001). Type GE/E = G showed a worse prognosis compared with Type G (<italic>P</italic> &lt; 0.05). Subgroup analysis stratified by Nishi's classification, Stage IA-IIB and IIIA, and tumor size ≤ 30 mm indicated significant survival advantages for the THPG group (<italic>P</italic> &lt; 0.05). However, this analysis failed to show a survival benefit in Stage IIIB (<italic>P</italic> &gt; 0.05).</p><p><bold>Conclusions:</bold> Nishi's classification is an effective method to clarify the subdivision of Siewert II tumors with a diameter ≤ 40 mm above or below the EGJ. THPG with EPL is an optimal procedure for the patients with the stomach-predominant EGJ tumors ≤30 mm in diameter and in Stage IA-IIIA. For more advanced and larger EGJ tumors, further studies are required to confirm the necessity of THTG with CPL.</p>