Abstract
Background:
The incidence of gastric adenocarcinoma is declining, while cases located in the proximal stomach are increasing. Surgery remains the primary curative treatment option for gastric cancer. Debate persists regarding the optimal surgical approach for Siewert type II esophagogastric junction adenocarcinoma. This study aims to assess the outcomes of these surgical options based on real-world data, evaluating overall survival, mortality, anastomosis failure and complication rates.
Methods:
Between 2001 and 2021, 1015 patients underwent esophagectomy and total gastrectomy. After exclusions, 139 patients with Siewert type II adenocarcinoma were included.
Results:
Among 139 patients, the median age was 61.58 years, with a predominance of males. Total gastrectomy had a shorter hospital stay (p<0.01) and lower rates of anastomosis failure (p<0.001) and severe morbidity (p<0.05) compared to esophagectomy. Mortality rates at 30 and 90 days did not differ between the two groups. Tumor size was larger in the gastrectomy group (p<0.05). Locally advanced disease was predominant (89.2%). Overall five-year survival was 38.7%, with no significant difference between surgical approaches (p=0.891).
Conclusion:
This study demonstrates that total gastrectomy and esophagectomy offer similar overall survival rates for Siewert type II adenocarcinoma patients. Factors such as tumor size, severe morbidity, and stage 4a significantly impact survival. Locally advanced disease is associated with worse survival. Total gastrectomy and esophagectomy yield comparable overall survival rates in Siewert type II esophagogastric adenocarcinoma. Severe morbidity is a critical factor affecting survival and should be carefully considered when selecting the surgical approach.