ObjectiveTo discuss the pattern of lymph node metastasis for Siewert type Ⅱ adenocarcinoma of the esophagogastric junction and its appropriate surgical approach. MethodsWe retrospectively analyzed the clinical data of 162 patients with Siewert type Ⅱ adenocarcinoma of the esophagogastric junction who underwent curative resection in West China Hospital of Sichuan University from January 2007 through February 2010. The patients were divided into three groups based on their surgical approach, including 96 patients in a left thoracic group, 20 patients in an Ivor-Lewis group and 46 patients in an abdominal group. ResultsThere were 120 patients with lymph node metastasis. The lymph node metastatic rate was 74.1%. Simple thoracic lymph node metastasis was observed only in 2 patients (1.7%), 98 patients (81.7%) with simple abdominal lymph node metastasis, and 20 patients (16.6%) with both capacity lymph node metastasis. The thoracic approaches had an advantage in dissection lower mediastinal lymph node over the abdominal approach, while for the abdominal lymph node the result was reversed. There are 11 groups of lymph node with a more than 10% metastatic rate. ConclusionsThe abdominal lymph nodes are the dominating metastatic area of Siewert type Ⅱ AEG, but some important groups of lower mediastinal lymph node should be removed. In terms of curative resection of tumor, the Ivor-Lewis operated by a thoracic surgeon who is more familiar with the abdominal lymph node may be a reasonable choice.
ObjectiveTo systematically evaluate the efficacy and safety of proximal gastrectomy (PG) versus total gastrectomy (TG) for the treatment of Siewert type Ⅱ/Ⅲ adenocarcinoma of the esophagogastric junction (AEG). MethodsPubMed, The Cochrane Library, Web of Science, EMbase, CNKI, Wanfang, and VIP databases were searched for literature comparing the efficacy and safety of PG and TG for the treatment of Siewert type Ⅱ/Ⅲ AEG. The search period was from database inception to March 2023. Meta-analysis was performed using Review Manager 5.4 software. ResultsA total of 23 articles were included, including 16 retrospective cohort studies, 5 prospective cohort studies, and 2 randomized controlled trials. The total sample size was 2 826 patients, with 1 389 patients undergoing PG and 1 437 patients undergoing TG. Meta-analysis results showed that compared with TG, PG had less intraoperative blood loss [MD=−19.85, 95%CI (−37.20, −2.51), P=0.02] and shorter postoperative hospital stay [MD=−1.23, 95%CI (−2.38, −0.08), P=0.04]. TG had a greater number of lymph nodes dissected [MD=−6.20, 95%CI (−7.68, −4.71), P<0.001] and a lower incidence of reflux esophagitis [MD=3.02, 95%CI (1.24, 7.34), P=0.01]. There were no statistically significant differences between the two surgical approaches in terms of operative time, postoperative survival rate (1-year, 3-year, 5-year), and postoperative overall complications (P>0.05). ConclusionPG has advantages in terms of intraoperative blood loss and postoperative hospital stay, while TG has advantages in terms of the number of lymph nodes dissected and the incidence of reflux esophagitis. There is no significant difference in long-term survival between the two surgical approaches.