Published online Sep 14, 2015. doi: 10.3748/wjg.v21.i34.9999
Peer-review started: March 1, 2015
First decision: April 13, 2015
Revised: April 23, 2015
Accepted: July 15, 2015
Article in press: July 15, 2015
Published online: September 14, 2015
AIM: To explore a reasonable method of digestive tract reconstruction, namely, antrum-preserving double-tract reconstruction (ADTR), for patients with adenocarcinoma of the esophagogastric junction (AEG) and to assess its efficacy and safety in terms of long-term survival, complications, morbidity and mortality.
METHODS: A total of 55 cases were retrospectively collected, including 18 cases undergoing ADTR and 37 cases of Roux-en-Y reconstruction (RY) for AEG (Siewert types II and III) at North Sichuan Medical College. The cases were divided into two groups. The clinicopathological characteristics, perioperative outcomes, postoperative complications, morbidity and overall survival (OS) were compared for the two different reconstruction methods.
RESULTS: Basic characteristics including sex, age, body mass index (BMI), Siewert type, pT status, pN stage, and lymph node metastasis were similar in the two groups. No significant differences were found between the two groups in terms of perioperative outcomes (including the length of postoperative hospital stay, operating time, and intraoperative blood loss) and postoperative complications (consisting of anastomosis-related complications, wound infection, respiratory infection, pleural effusion, lymphorrhagia, and cholelithiasis). For the ADTR group, perioperative recovery indexes such as time to first flatus (P = 0.002) and time to resuming a liquid diet (P = 0.001) were faster than those for the RY group. Moreover, the incidence of reflux esophagitis was significantly decreased compared with the RY group (P = 0.048). The postoperative morbidity and mortality rates for overall postoperative complications and the rates of tumor recurrence and metastasis were not significantly different between the two groups. Survival curves plotted using the Kaplan-Meier method and compared by log-rank test demonstrated similar outcomes for the ADTR and RY groups. Multivariate analysis of significantly different factors that presented as covariates on Cox regression analysis to assess the survival and recurrence among AEG patients showed that age, gender, BMI, pleural effusion, time to resuming a liquid diet, lymphorrhagia and tumor-node-metastasis stage were important prognostic factors for OS of AEG patients, whereas the selection of surgical method between ADTR and RY was shown to be a similar prognostic factor for OS of AEG patients.
CONCLUSION: ADTR by jejunal interposition presents similar rates of tumor recurrence, metastasis and long-term survival compared with classical reconstruction with RY esophagojejunostomy; however, it offers considerably improved near-term quality of life, especially in terms of early recovery and decreased reflux esophagitis. Thus, ADTR is recommended as a worthwhile digestive tract reconstruction method for Siewert types II and III AEG.
Core tip: Antrum-preserving double-tract reconstruction (ADTR) was introduced to improve the near-term quality of life and decrease reflux esophagitis in patients with adenocarcinoma of the esophagogastric junction. The clinicopathological characteristics, perioperative outcomes, postoperative complications, morbidity and overall survival after ADTR and Roux-en-Y reconstruction (RY) (ADTR group, n = 18 vs RY group, n = 37) were retrospectively compared to evaluate the efficacy and safety of the procedures. The results of the study demonstrated that ADTR was technically safe and feasible, offering an agreeable near-term quality of life, especially in terms of early recovery and the alleviation of reflux esophagitis. ADTR may be a worthwhile digestive tract reconstruction method for Siewert types II and III adenocarcinoma of the esophagogastric junction.