SiewertⅡ/Ⅲ型胃食管结合部腺癌近切缘长度的临床意义

The clinical significance of proximal margin length in Siewert Ⅱ/Ⅲ adenocarcinoma of esophagogastric junction

目的:探讨SiewertⅡ/Ⅲ型胃食管结合部腺癌近切缘长度的临床意义。方法:收集2004年1月至2018年12月手术治疗的SiewertⅡ/Ⅲ型胃食管结合部腺癌患者的临床资料。采用X-tile软件确定近切缘长度的最佳截值;通过χ^(2)检验、t检验进行单因素分析,logistic回归进行多因素分析,Kaplan-Meier法绘制生存曲线。结果:共纳入166例患者,其中腹腔镜组86例,开腹组80例。X-tile软件确定近切缘长度最佳截值为1.5 cm。近切缘长度≤1.5 cm的5年生存率小于近切缘长度>1.5 cm(39.5%vs.64.1%,P=0.017),差异有统计学意义;近切缘长度≤1.5 cm时,腹腔镜组与开腹组5年生存率差异无统计学意义(29.4%vs.48.3%,P=0.797);近切缘长度>1.5 cm时,腹腔镜组5年生存率大于开腹组(70.8%vs.54.1%,P=0.031),差异有统计学意义。腹腔镜组手术时间较长,但术中出血量少,清扫淋巴结数量多,术后住院时间短。单因素分析结果显示,术后T分期、术后N分期、近切缘长度是影响患者预后的危险因素(P=0.013,0.009,0.017)。多因素logistic回归模型显示,近切缘长度是影响患者预后的独立危险因素(OR=3.125,95%CI:1.459-6.695,P=0.003)。结论:在保证近切缘长度>1.5 cm的基础上,选择腹腔镜手术利于减少术中出血量、清扫更多的淋巴结、缩短术后住院时间。

Objective:To investigate the clinical significance of the proximal margin length of SiewertⅡ/Ⅲesophagogastric junction adenocarcinoma.Methods:The clinical data of patients who suffered from SiewertⅡ/Ⅲesophagogastric junction adenocarcinoma and underwent surgery from Jan.2004 to Dec.2018 were collected.X-tile software was used to determine the optimal cut-off value of the proximal margin length.Univariate analysis was carried out by chi-squared test and t-test,and multivariate analysis was carried out by logistic regression.Kaplan-Meier method was used to plot the survival curve.Results:A total of 166 patients were included in this study,including 86 cases of laparoscopic treatment and 80 cases of open surgery.X-tile software showed that the optimal cut-off value of the length of the proximal margin was 1.5 cm.The 5-year survival rate of patients with the length of proximal margin≤1.5 cm was less than the patients with the length of proximal margin>1.5 cm(39.5%vs.64.1%,P=0.017),the difference was statistically significant.When the length of the proximal margin was≤1.5 cm,there was no significant difference in the 5-year survival rate between laparoscopic group and open group(29.4%vs.48.3%,P=0.797).When the length of proximal margin>1.5 cm,the 5-year survival rate of laparoscopic group was significantly higher than that of the open group(70.8%vs.54.1%,P=0.031).The operation time of laparoscopic group was longer,but the intraoperative blood loss was less,the number of lymph nodes harvested was more,and the postoperative hospital stay was shorter.Univariate analysis showed that postoperative T stage,postoperative N stage and proximal margin length were risk factors affecting the prognosis of patients(P<0.05).Multivariate logistic regression model showed that the length of proximal margin was an independent risk factor affecting the prognosis(OR=3.125,95%CI:1.459-6.695,P=0.003).Conclusions:On the basis of ensuring that the length of the proximal margin is longer than 1.5 cm,the choice of laparoscopic operation is conducive to reducing the intraoperative blood loss,dissecting more lymph nodes and shortening the postoperative hospital stay.