Surgical Strategies for Siewert Type II Esophagogastric Junction Carcinomas: A Randomized Controlled Trial

Kai Tao; Jianhong Dong; Songbing He; Yingying Xu; Fan Yang; Guolin Han; Masanobu Abe; Liang Zong

doi:10.3389/fonc.2022.852594

Surgical Strategies for Siewert Type II Esophagogastric Junction Carcinomas: A Randomized Controlled Trial

Front Oncol. 2022 Jun 23:12:852594. doi: 10.3389/fonc.2022.852594. eCollection 2022.

Authors

Kai Tao¹, Jianhong Dong¹, Songbing He², Yingying Xu³, Fan Yang⁴, Guolin Han⁵, Masanobu Abe⁶, Liang Zong⁷

Affiliations

¹ Department of Gastrointestinal Surgery, Shanxi Cancer Hospital, Shanxi Medical University, Taiyuan, China.
² Department of General Surgery, The First Affiliated Hospital of Soochow University, Suzhou, China.
³ Department of General Surgery, Yizhen People's Hospital, Clinical Medical College, Yangzhou University, Yangzhou, China.
⁴ Department of Central Laboratory, Changzhi People's Hospital, The Affiliated Hospital of Shanxi Medical University, Changzhi, China.
⁵ Department of Medical Records Room, Changzhi People's Hospital, The Affiliated Hospital of Shanxi Medical University, Changzhi, China.
⁶ Graduate School of Medicine, University of Tokyo, Tokyo, Japan.
⁷ Department of Gastrointestinal Surgery, Changzhi People's Hospital, The Affiliated Hospital of Shanxi Medical University, Changzhi, China.

Abstract

Aim: To determine the ideal surgical approach for Siewert type II EGJ carcinomas.

Methods: We 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.

Results: Among 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.

Conclusions: Proximal 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 registration: https://www.chictr.org.cn/, identifier ChiCTR-IIR-16007733.

Keywords: Roux-en-Y Esophagojejunostomy; Siewert type II esophagogastric junction carcinoma; esophagogastrostomy; jejunal interposition; proximal gastrectomy; total gastrectomy.