Objective： To compare the survival outcomes of transabdominal （TA） and transthoracic （TT） surgical approaches in patients with Siewert-II/III esophagogastric junction adenocarcinoma. Methods： This retrospective ...Objective： To compare the survival outcomes of transabdominal （TA） and transthoracic （TT） surgical approaches in patients with Siewert-II/III esophagogastric junction adenocarcinoma. Methods： This retrospective study was conducted in patients with Siewert-II/III esophagogastric junction adenocarcinoma who underwent either TT or TA operations in the West China Hospital between January 2006 and December 2009. Results： A total of 308 patients （109 in the TT and 199 in the TA groups） were included in this study with a follow-up rate of 87.3%. The median （P25, P75） number of harvested perigastric lymph nodes was 8 （5, 10） in the TT group and 23 （16, 34） in the TA group （P〈0.001）, and the number of positive perigastric lymph nodes was 2 （0, 5） in the TT group and 3 （1, 8） in the TA group （P〈0.004）. The 5-year overall survival （OS） rate was 36% in the TT group and 51% in the TA group （P=0.005）. Subgroup analysis by Siewert classification showed that 5-year OS rates for patients with Siewert II tumors were 38% and 48% in TT and TA groups, respectively （P=0.134）, whereas the 5-year OS rate for patients with Siewert III tumors was significantly lower in the TT group than that in the TA group （33% vs. 53%; P=0.010）. Multivariate analysis indicated that N2 and N3 stages, RI/R2 resection and a TT surgical approach were prognostic factors for poor OS. Conclusions： Improved perigastric lymph node dissection may be the main reason for better survival outcomes observed with a TA gastrectomy approach than with TT gastrectomy for Siewert III tumor patients.展开更多
食管胃结合部腺癌(adenocarcinoma of esophagogastric junction,AEG)发病率呈逐年上升趋势,Siewert分型的提出为AEG手术治疗提供了统一的参考标准。X线气钡双对比造影、计算机体层摄影(computer tomography,CT)等影像学检查手段作为AE...食管胃结合部腺癌(adenocarcinoma of esophagogastric junction,AEG)发病率呈逐年上升趋势,Siewert分型的提出为AEG手术治疗提供了统一的参考标准。X线气钡双对比造影、计算机体层摄影(computer tomography,CT)等影像学检查手段作为AEG重要诊断方法之一,不仅能够检出AEG,还可对其进行分型与分期评估,有利于指导制订规范化、个性化的治疗方案。本文将从Siewert分型及其特征、AEG影像学诊断等方面展开综述。展开更多
目的分析食管胃结合部腺癌(adenocarcinoma of the esophagogastric junction,AEJ)患者不同Siewert分型中RBC、NLR及临床特征。方法采用回顾性分析方法收集延安大学附属医院2017年1月1日至2018年12月31日消化内科及胃肠外科进行手术治疗...目的分析食管胃结合部腺癌(adenocarcinoma of the esophagogastric junction,AEJ)患者不同Siewert分型中RBC、NLR及临床特征。方法采用回顾性分析方法收集延安大学附属医院2017年1月1日至2018年12月31日消化内科及胃肠外科进行手术治疗的55例AEJ患者的临床病理资料,分析AEJ患者不同Siewert分型中各项指标及临床特征的变化。结果在不同Siewert分型中,RBC、NLR、肿瘤大小、淋巴结转移比较,差异有统计学意义(P<0.05)。对RBC、NLR、肿瘤大小、淋巴结转移分别进行组内两两比较,发现SiewertⅢ型中RBC值高于SiewertⅡ型,且差异有统计学意义(P<0.05);SiewertⅢ型中NLR值低于SiewertⅡ型,差异有统计学意义(P<0.05);从SiewertⅠ型到SiewertⅢ型,肿瘤的长径逐渐增大且3种Siewert分型相互之间两两比较,差异均有统计学意义(P<0.05);SiewertⅠ型到SiewertⅢ型淋巴结转移率越来越大,差异有统计学意义(P<0.05)。结论不同Siewert分型的AEJ患者具有不同的临床病理特征,SiewertⅢ型与SiewertⅡ型相比RBC水平较高,而NLR却较低;相比于另外两型,SiewertⅢ型肿瘤可能相对较大,淋巴结转移率相对较高,生物学行为可能较差。展开更多
基金supported by National Natural Science Foundation of China(No.81372344)
文摘Objective： To compare the survival outcomes of transabdominal （TA） and transthoracic （TT） surgical approaches in patients with Siewert-II/III esophagogastric junction adenocarcinoma. Methods： This retrospective study was conducted in patients with Siewert-II/III esophagogastric junction adenocarcinoma who underwent either TT or TA operations in the West China Hospital between January 2006 and December 2009. Results： A total of 308 patients （109 in the TT and 199 in the TA groups） were included in this study with a follow-up rate of 87.3%. The median （P25, P75） number of harvested perigastric lymph nodes was 8 （5, 10） in the TT group and 23 （16, 34） in the TA group （P〈0.001）, and the number of positive perigastric lymph nodes was 2 （0, 5） in the TT group and 3 （1, 8） in the TA group （P〈0.004）. The 5-year overall survival （OS） rate was 36% in the TT group and 51% in the TA group （P=0.005）. Subgroup analysis by Siewert classification showed that 5-year OS rates for patients with Siewert II tumors were 38% and 48% in TT and TA groups, respectively （P=0.134）, whereas the 5-year OS rate for patients with Siewert III tumors was significantly lower in the TT group than that in the TA group （33% vs. 53%; P=0.010）. Multivariate analysis indicated that N2 and N3 stages, RI/R2 resection and a TT surgical approach were prognostic factors for poor OS. Conclusions： Improved perigastric lymph node dissection may be the main reason for better survival outcomes observed with a TA gastrectomy approach than with TT gastrectomy for Siewert III tumor patients.
文摘食管胃结合部腺癌(adenocarcinoma of esophagogastric junction,AEG)发病率呈逐年上升趋势,Siewert分型的提出为AEG手术治疗提供了统一的参考标准。X线气钡双对比造影、计算机体层摄影(computer tomography,CT)等影像学检查手段作为AEG重要诊断方法之一,不仅能够检出AEG,还可对其进行分型与分期评估,有利于指导制订规范化、个性化的治疗方案。本文将从Siewert分型及其特征、AEG影像学诊断等方面展开综述。
文摘目的分析食管胃结合部腺癌(adenocarcinoma of the esophagogastric junction,AEJ)患者不同Siewert分型中RBC、NLR及临床特征。方法采用回顾性分析方法收集延安大学附属医院2017年1月1日至2018年12月31日消化内科及胃肠外科进行手术治疗的55例AEJ患者的临床病理资料,分析AEJ患者不同Siewert分型中各项指标及临床特征的变化。结果在不同Siewert分型中,RBC、NLR、肿瘤大小、淋巴结转移比较,差异有统计学意义(P<0.05)。对RBC、NLR、肿瘤大小、淋巴结转移分别进行组内两两比较,发现SiewertⅢ型中RBC值高于SiewertⅡ型,且差异有统计学意义(P<0.05);SiewertⅢ型中NLR值低于SiewertⅡ型,差异有统计学意义(P<0.05);从SiewertⅠ型到SiewertⅢ型,肿瘤的长径逐渐增大且3种Siewert分型相互之间两两比较,差异均有统计学意义(P<0.05);SiewertⅠ型到SiewertⅢ型淋巴结转移率越来越大,差异有统计学意义(P<0.05)。结论不同Siewert分型的AEJ患者具有不同的临床病理特征,SiewertⅢ型与SiewertⅡ型相比RBC水平较高,而NLR却较低;相比于另外两型,SiewertⅢ型肿瘤可能相对较大,淋巴结转移率相对较高,生物学行为可能较差。
