SiewertⅡ/Ⅲ型食管胃结合部腺癌上切缘安全距离界定

The determination of safety margin of Siewert typeⅠ/Ⅲadenocarcinoma of esophagogastric junction

目的界定食管胃结合部腺癌(adenocarcinoma of esphagogastric junction,AEG)SiewertⅡ/Ⅲ型安全上切缘切除距离,并测定不同张力状态(术中和术后)下食管下段的弹性回缩系数,为术中选取合适的上切缘提供参考依据。方法选取郑州大学第一附属医院2018年1月至2019年3月71例行近端及全胃胃癌根治术的连续病例资料为研究资料,其中男性病人59例,女性病人12例,年龄为(62.0±9.0)岁(25~82岁),手术标本离体固定后距肿瘤上缘0.5、1.0、1.5、2.0、2.5、3.0、3.5 cm行环周病理检测,并测定肿瘤上切缘术中及离体后长度,计算AEG上切缘弹性回缩系数,进而分析病人的临床病理因素与AEG上切缘浸润距离及弹性回缩系数的关系。结果距肿瘤上切缘0.5、1.0、1.5、2.0、2.5、3.0、3.5 cm切缘阳性率分别是32.4%、21.1%、15.5%、12.7%、5.6%、0和0。AEG上切缘浸润距离在下列因素中差异有统计学意义:肿瘤大小(t=2.545,P=0.013);Borrmann分型(t=6.066,P<0.001);Lauren分型(t=2.207,P=0.032);肿瘤分化程度(t=2.855,P=0.006);T分期(t=4.567,P<0.001);N分期(t=2.800,P=0.010)及pTNM分期(t=4.556,P<0.001)。AEG食管下段离体后弹性回缩系数为0.342±0.083。且在下列因素中差异有统计学意义:性别(t=2.676,P=0.009);年龄(t=2.588,P=0.012);体质量指数(t=2.517,P=0.014);肿瘤大小(t=2.685,P=0.012);Borrmann分型(t=2.409,P=0.020);T分期(t=2.725,P=0.009)及pTNM分期(t=2.422,P=0.020)。结论SiewertⅡ/Ⅲ型AEG术后离体上切缘3.0 cm为最小安全切除距离;术中上切缘4.6 cm为最小安全切除距离;但上切缘安全切除距离与病人性别、年龄、体质量指数、肿瘤大小、Borrmann分型、T分期及pTNM分期有关。

Objective To define the safe upper resection margin resection distance of Siewert typeⅡ/Ⅲadenocarcinoma of esphagogastric junction(AEG),and to determine the elastic recoil coefficient of the lower esophagus under different tension states(intraoperative and postoperative)to provide a reference basis for selecting the appropriate upper resection margin during surgery.Methods Seventy-one consecutive patients who underwent radical gastrectomy for gastric cancer from January 2018 to March 2019 in the First Affiliated Hospital of Zhengzhou University were selected as the study data,including 59 male patients and 12 female patients,aged(62.0±9.0)years(range,25-82 years).Circumferential pathological examination was performed 0.5,1.0,1.5,2.0,2.5,3.0 and 3.5 cm from the upper edge of the tumor after surgical specimen fixation.The intraoperative and postoperative lengths of the upper resection margin of the tumor were measured.The elastic shrinkage coefficient of the upper resection margin of the AEG was calculated,and then the relationship between the clinicopathological factors of the patients and the infiltration distance and elastic shrinkage coefficient of the upper resection margin of the AEG was analyzed.Results The positive rates were 32.4%,21.1%,15.5%,12.7%,5.6%,1.4%,0 and 0,respectively,from the upper resection margins of 0.5 cm,1.0 cm,1.5 cm,2.0 cm,2.5 cm,3.0 cm and 3.5 cm.The distance of margin invasion on AEG was significantly correlated with tumor size(t=2.545,P=0.013),Borrmann classification(t=6.066,P<0.001),Lauren classification(t=2.207,P=0.032),tumor differentiation(t=2.855,P=0.006),T stage(t=4.567,P<0.001),N stage(t=2.800,P=0.010)and pTNM stage(t=4.556,P<0.001).The elastic recoil coefficient of AEG was 0.342±0.083.And it was significantly correlated with gender(t=2.676,P=0.009),age(t=2.588,P=0.012),BMI(t=2.517,P=0.014),tumor size(t=2.685,P=0.012),Borrmann classification(t=2.409,P=0.020),T stage(t=2.725,P=0.009)and pTNM(t=2.422,P=0.020)stage.Conclusion The minimum safe resection distance is 3.0 cm in the upper resection margin and 4.6 cm in the upper resection margin after Siewert typeⅡ/Ⅲgastroesophageal junction tumor surgery,but the safe resection distance of the upper resection margin is related to the patient's gender,age,BMI,tumor size,Borrmann classification,T stage and pTNM stage.