Surgical Strategies for Siewert Type II Esophagogastric Junction Carcinomas: A Randomized Controlled Trial
AimTo determine the ideal surgical approach for Siewert type II EGJ carcinomas.MethodsWe conducted the randomized controlled trial (RCT) at Shanxi Cancer Hospital from January 2014 to August 2016. A total of 105 patients with T1-4N1-3M0 Siewert type II EGJ carcinomas were initially recruited. The fi...
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Frontiers Media S.A.
2022-06-01
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| Series: | Frontiers in Oncology |
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| Online Access: | https://www.frontiersin.org/articles/10.3389/fonc.2022.852594/full |
| _version_ | 1818547569550163968 |
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| author | Kai Tao Jianhong Dong Songbing He Yingying Xu Fan Yang Guolin Han Masanobu Abe Liang Zong |
| author_facet | Kai Tao Jianhong Dong Songbing He Yingying Xu Fan Yang Guolin Han Masanobu Abe Liang Zong |
| author_sort | Kai Tao |
| collection | DOAJ |
| description | AimTo determine the ideal surgical approach for Siewert type II EGJ carcinomas.MethodsWe conducted the randomized controlled trial (RCT) at Shanxi Cancer Hospital from January 2014 to August 2016. A total of 105 patients with T1-4N1-3M0 Siewert type II EGJ carcinomas were initially recruited. The final follow-up was up to June 30, 2019. Patients were randomized to undergo either a proximal gastrectomy plus jejunal interposition (PG+JI), proximal gastrectomy plus esophagogastrostomy (PG+EG), or total gastrectomy plus Roux-en-Y esophagojejunostomy (TG+RY). The primary endpoint was postoperative complications. Secondary endpoints were 5-year survival and recovery indexes.ResultsAmong 105 patients, 100 patients (95.2%; mean age, 56.2 years) with tumors <3cm in size underwent surgery: PG+JI (n=33) vs. PG+EG (n=33) and TG+RY (n=34); 91 patients completed the study. Among the groups, the PG+JI group had the longest reconstruction time: 34.11 ± 6.10 min vs. 21.97 ± 3.30 min (PG+EG) vs. 30.56 ± 4.26 min (TG+RY); p<0.001. There was no postoperative mortality. In the per-protocol analysis, the PG+JI group showed a decreased tendency in complication rate: 6.9% vs. 23.3% (PG+EG) vs. 18.8% (TG+RY), but there was no significant difference. For recovery indexes, the TG+RY group had the lowest values of the amount of single meal, weight loss, hemoglobin, albumin, pepsin, and gastrin among the three groups. There was no significant difference among the three groups in 5-year survival.ConclusionsProximal gastrectomy is preferable for T1-4N1-3M0 Siewert type II EGJ carcinomas with tumors <3cm in size because of its better nutrition status under similar postoperative complication to total gastrectomy. Jejunal interposition can be recommended as a optional reconstruction approach after proximal gastrectomy.Clinical Trial Registrationhttps://www.chictr.org.cn/, identifier ChiCTR-IIR-16007733. |
| first_indexed | 2024-12-12T08:08:29Z |
| format | Article |
| id | doaj.art-b852bb6393c545da9719ff28eb1ad00d |
| institution | Directory Open Access Journal |
| issn | 2234-943X |
| language | English |
| last_indexed | 2024-12-12T08:08:29Z |
| publishDate | 2022-06-01 |
| publisher | Frontiers Media S.A. |
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| series | Frontiers in Oncology |
| spelling | doaj.art-b852bb6393c545da9719ff28eb1ad00d2022-12-22T00:31:53ZengFrontiers Media S.A.Frontiers in Oncology2234-943X2022-06-011210.3389/fonc.2022.852594852594Surgical Strategies for Siewert Type II Esophagogastric Junction Carcinomas: A Randomized Controlled TrialKai Tao0Jianhong Dong1Songbing He2Yingying Xu3Fan Yang4Guolin Han5Masanobu Abe6Liang Zong7Department of Gastrointestinal Surgery, Shanxi Cancer Hospital, Shanxi Medical University, Taiyuan, ChinaDepartment of Gastrointestinal Surgery, Shanxi Cancer Hospital, Shanxi Medical University, Taiyuan, ChinaDepartment of General Surgery, The First Affiliated Hospital of Soochow University, Suzhou, ChinaDepartment of General Surgery, Yizhen People’s Hospital, Clinical Medical College, Yangzhou University, Yangzhou, ChinaDepartment of Central Laboratory, Changzhi People’s Hospital, The Affiliated Hospital of Shanxi Medical University, Changzhi, ChinaDepartment of Medical Records Room, Changzhi People’s Hospital, The Affiliated Hospital of Shanxi Medical University, Changzhi, ChinaGraduate School of Medicine, University of Tokyo, Tokyo, JapanDepartment of Gastrointestinal Surgery, Changzhi People’s Hospital, The Affiliated Hospital of Shanxi Medical University, Changzhi, ChinaAimTo determine the ideal surgical approach for Siewert type II EGJ carcinomas.MethodsWe conducted the randomized controlled trial (RCT) at Shanxi Cancer Hospital from January 2014 to August 2016. A total of 105 patients with T1-4N1-3M0 Siewert type II EGJ carcinomas were initially recruited. The final follow-up was up to June 30, 2019. Patients were randomized to undergo either a proximal gastrectomy plus jejunal interposition (PG+JI), proximal gastrectomy plus esophagogastrostomy (PG+EG), or total gastrectomy plus Roux-en-Y esophagojejunostomy (TG+RY). The primary endpoint was postoperative complications. Secondary endpoints were 5-year survival and recovery indexes.ResultsAmong 105 patients, 100 patients (95.2%; mean age, 56.2 years) with tumors <3cm in size underwent surgery: PG+JI (n=33) vs. PG+EG (n=33) and TG+RY (n=34); 91 patients completed the study. Among the groups, the PG+JI group had the longest reconstruction time: 34.11 ± 6.10 min vs. 21.97 ± 3.30 min (PG+EG) vs. 30.56 ± 4.26 min (TG+RY); p<0.001. There was no postoperative mortality. In the per-protocol analysis, the PG+JI group showed a decreased tendency in complication rate: 6.9% vs. 23.3% (PG+EG) vs. 18.8% (TG+RY), but there was no significant difference. For recovery indexes, the TG+RY group had the lowest values of the amount of single meal, weight loss, hemoglobin, albumin, pepsin, and gastrin among the three groups. There was no significant difference among the three groups in 5-year survival.ConclusionsProximal gastrectomy is preferable for T1-4N1-3M0 Siewert type II EGJ carcinomas with tumors <3cm in size because of its better nutrition status under similar postoperative complication to total gastrectomy. Jejunal interposition can be recommended as a optional reconstruction approach after proximal gastrectomy.Clinical Trial Registrationhttps://www.chictr.org.cn/, identifier ChiCTR-IIR-16007733.https://www.frontiersin.org/articles/10.3389/fonc.2022.852594/fullSiewert type II esophagogastric junction carcinomaproximal gastrectomytotal gastrectomyjejunal interpositionesophagogastrostomyRoux-en-Y Esophagojejunostomy |
| spellingShingle | Kai Tao Jianhong Dong Songbing He Yingying Xu Fan Yang Guolin Han Masanobu Abe Liang Zong Surgical Strategies for Siewert Type II Esophagogastric Junction Carcinomas: A Randomized Controlled Trial Frontiers in Oncology Siewert type II esophagogastric junction carcinoma proximal gastrectomy total gastrectomy jejunal interposition esophagogastrostomy Roux-en-Y Esophagojejunostomy |
| title | Surgical Strategies for Siewert Type II Esophagogastric Junction Carcinomas: A Randomized Controlled Trial |
| title_full | Surgical Strategies for Siewert Type II Esophagogastric Junction Carcinomas: A Randomized Controlled Trial |
| title_fullStr | Surgical Strategies for Siewert Type II Esophagogastric Junction Carcinomas: A Randomized Controlled Trial |
| title_full_unstemmed | Surgical Strategies for Siewert Type II Esophagogastric Junction Carcinomas: A Randomized Controlled Trial |
| title_short | Surgical Strategies for Siewert Type II Esophagogastric Junction Carcinomas: A Randomized Controlled Trial |
| title_sort | surgical strategies for siewert type ii esophagogastric junction carcinomas a randomized controlled trial |
| topic | Siewert type II esophagogastric junction carcinoma proximal gastrectomy total gastrectomy jejunal interposition esophagogastrostomy Roux-en-Y Esophagojejunostomy |
| url | https://www.frontiersin.org/articles/10.3389/fonc.2022.852594/full |
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