Comparison of clinical outcome & prognosis in patients with GEJ adenocarcinoma by transthoracic and transabdominal hiatal approaches: A single Chinese teaching hospital retrospective cohort study

Shougen Cao, Yanbing Zhou, Jinzhe Zhou. Affiliated Hospital of Qingdao University

Objective: To compare the clinical outcome and prognosis in patients with gastroesophageal junction adenocarcinoma (Siewert type?) by transthoracic and transabdominal hiatal approaches.

Methods: 334 cases Siewert ?/? GEJ adenocarcinomas patients underwent different surgical procedures in Affiliated Hospital of Qingdao University from July 2007 to July 2012 were analysed retrospectively. Of which 140 cases by transthoracic approach, 194 cases by transabdominal hiatal approach mainly underwent radical total and proximal gastrectomy(D2).All the patients were followed up by telephone review or outpatients’ reexamination until July 2013. The surgical-related and clinical outcomes were compared using the chi-square test, t test, Fisher’s exact test or nonparametric rank sum test according to different dates. The survival curve was drawn by the Kaplan-Meier method and survival analysis used Log-rank test.

Results: The operative time, length of resected esophagus, number of lymph nodes harvested, postoperative pain scores, postoperative hospital stay, time of antibiotics use, postoperative morbidity and costs, transabdominal surgery group was better than that of transthoracic group (202±34 vs 153±48. t=3.126,4.1±1.1 vs 3.8±1.1. t=2.634,17±7 vs 22±7. t=5.417, 5.9±1.8 vs 4.8±1.6. t=4.662,13±6 vs 11±6. t=2.030,6.8±2.4 vs 2.3±1.1. t=9.384,27.14% vs 15.46%. χ2=6.841,4.7±1.8 vs 4.5±1.5. t=2.398,P <0.05) . The follow-up rate was 90.42%(302/334) and the median survival time was 38 months in 2-72 months. The overall 5-year survival rate was 35.3% and 40.3% respectively in transthoracic and transabdominal surgery group, there were not statistically differences between them (χ2 = 2.311, P >0.05). According to TNM staging, stratification analysis showed that that staging III patients’ overall survival rates were 25.7% and 37.2 % separately, the difference was statistically significant (χ2 = 4.127, P <0.05).

Conclusion: There was no significant differences of 5-year overall survival in TNM stage I and II of Siewert II / III adenocarcinoma patients but improved survival of TNM stage III by transabdominal hiatal compared with transthoracic radical total and proximal gastrectomy,There was more dominant short-term clinical outcomes improving in transabdominal hiatial approach group.

Keywords: Gastroesophageal Junction Adenocarcinoma, Surgical Approach, Survival, Postoperative Complications

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