Retrospective Study
Copyright ©The Author(s) 2021. Published by Baishideng Publishing Group Inc. All rights reserved.
World J Gastroenterol. Mar 7, 2021; 27(9): 854-865
Published online Mar 7, 2021. doi: 10.3748/wjg.v27.i9.854
Surgical resection of esophagogastric junction stromal tumor: How to protect the cardiac function
Guo-Liang Zheng, Bao Zhang, Yue Wang, Yong Liu, Hai-Tao Zhu, Yan Zhao, Zhi-Chao Zheng
Guo-Liang Zheng, Bao Zhang, Yue Wang, Yong Liu, Hai-Tao Zhu, Yan Zhao, Zhi-Chao Zheng, Department of Gastric Surgery, Cancer Hospital of China Medical University (Liaoning Cancer Hospital and Institute), Shenyang 110042, Liaoning Province, China
Author contributions: Zheng GL conceived the study and drafted the manuscript; Zhang B and Wang Y collected the data and participated in drafting the manuscript; Liu Y and Zhu HT performed statistical analysis; Zhao Y and Zheng ZC designed and supervised the study; all authors contributed to the writing of the manuscript and provided final approval of the manuscript; all authors have read and approved the final version of this manuscript; All authors agreed to be accountable for all aspects of the work in ensuring that questions related to the accuracy or integrity of any part of the work are appropriately investigated and resolved.
Supported by Natural Science Foundation of Liaoning Province, No. 20170540567.
Institutional review board statement: This study was reviewed and approved by the Cancer Hospital of China Medical University (Liaoning Cancer Hospital and Institute) Institutional Review Board (approval No. 20190461).
Informed consent statement: All study participants, or their legal guardian, provided informed written consent prior to study enrollment.
Conflict-of-interest statement: We have no financial relationships to disclose.
Data sharing statement: The datasets used and/or analyzed during the current study are available from the corresponding author on reasonable request.
Open-Access: This article is an open-access article that was selected by an in-house editor and fully peer-reviewed by external reviewers. It is distributed in accordance with the Creative Commons Attribution NonCommercial (CC BY-NC 4.0) license, which permits others to distribute, remix, adapt, build upon this work non-commercially, and license their derivative works on different terms, provided the original work is properly cited and the use is non-commercial. See: http://creativecommons.org/Licenses/by-nc/4.0/
Corresponding author: Zhi-Chao Zheng, MD, PhD, Chief Doctor, Professor, Department of Gastric Surgery, Cancer Hospital of China Medical University (Liaoning Cancer Hospital and Institute), No. 44 Xiaoheyan Road, Shenyang 110042, Liaoning Province, China. drzhengzc@126.com
Received: November 28, 2020
Peer-review started: November 28, 2020
First decision: January 17, 2021
Revised: January 23, 2021
Accepted: February 11, 2021
Article in press: February 11, 2021
Published online: March 7, 2021
Abstract
BACKGROUND

Various surgical procedures have been described for gastrointestinal stromal tumors (GISTs) at the esophagogastric junction (EGJ) close to the Z-line. However, surgery for EGJ-GIST involving Z-line has been rarely reported.

AIM

To introduce a novel technique called conformal resection (CR) for open resection of EGJ-GIST involving Z-line.

METHODS

In this retrospective study, 43 patients having GISTs involving Z-line were included. The perioperative outcomes of patients receiving CR (n = 18) was compared with that of proximal gastrectomy (PG) (n = 25).

RESULTS

CR was successfully performed in all the patients with negative microscopic margins. The mean operative time, time to first passage of flatus, and postoperative hospital stay was significantly shorter in the CR group (P < 0.05), while the intraoperative blood loss was similar in the two groups. The postoperative gastroesophageal reflux as diagnosed by esophageal 24-h pH monitoring and quality of life at 3 mo were significantly in favor of CR compared to PG (both P < 0.001). The 5-year disease-free survival between the two groups was similar (P = 0.163). The cut- off value for the determination of CR or PG was 7.0 mm above the Z-line (83.33% sensitivity, 84.00% specificity, 83.72% accuracy).

CONCLUSION

CR is safe and feasible for EGJ-GIST located within 7.0 mm above the Z-line.

Keywords: Esophagogastric junction stromal tumor, Surgery, Anti-reflux, 36-Item short-form health survey, Disease-free survival

Core Tip: We retrospectively enrolled 43 cases of esophagogastric junction-gastrointestinal stromal tumor (EGJ-GIST) involving Z-line, including 25 cases in the proximal gastrectomy (PG) group and 18 cases in the conformal resection (CR) group. The operation CR was introduced, and the following indicators were analyzed: Clinicopathological characteristics, perioperative outcomes, postoperative esophageal 24-h pH, postoperative quality of life, and 5-year disease-free survival. Finally, the cut-off value above the Z-line for the determination of CR or PG was determined. Our results confirm that CR is safe and feasible for EGJ-GIST located within 7.0 mm above the Z-line. CR was associated with lower incidence of postoperative gastroesophageal reflux and better quality of life with similar oncological outcomes compared to PG.