Transthoracic, thoracoabdominal, and transabdominal surgical approaches for gastric cardia adenocarcinomas: a survival evaluation based on a cohort of 7103 patients

Posted on 29.06.2022 - 06:17
Abstract Background This study compared the survival outcomes of different surgical approaches to determine the optimal approach for gastric cardia adenocarcinoma (GCA) and aimed to standardize the surgical treatment guidelines for GCA. Methods A total of 7103 patients with GCA were enrolled from our previously established gastric cardia and esophageal carcinoma databases. In our database, when the epicenter of the tumor was at or within 2 cm distally from the esophagogastric junction, the adenocarcinoma was considered to originate from the cardia and was considered a Siewert type 2 cancer. The main criteria for the enrolled patients included treatment with radical surgery, no radio- or chemotherapy before the operation, and detailed clinicopathological information. Follow-up was mainly performed by telephone or through home interviews. According to the medical records, the surgical approaches included transthoracic, thoracoabdominal, and transabdominal approaches. Kaplan–Meier and Cox proportional hazards regression models were applied to correlate the surgical approach with survival in patients with GCA. Results There were marked differences in age and tumor stage among the patients who underwent the three surgical approaches (P < 0.001). Univariate analysis showed that survival was related to sex, age, tumor stage, and N stage (P < 0.001 for all). Cox regression model analysis revealed that thoracoabdominal approach (P < 0.001) and transabdominal approach (P < 0.001) were significant risk factors for poor survival. GCA patients treated with the transthoracic approach had the best survival (5-year survival rate of 53.7%), and survival varied among the different surgical approaches for different tumor stages. Conclusion Thoracoabdominal approach and transabdominal approach were shown to be poor prognostic factors. Patients with (locally advanced) GCA may benefit from the transthoracic approach. Further prospective randomized clinical trials are necessary.

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Chen, Yao; Zhao, Xue Ke; Xu, Rui Hua; Song, Xin; Yang, Miao Miao; Zhou, Fu You; et al. (2022): Transthoracic, thoracoabdominal, and transabdominal surgical approaches for gastric cardia adenocarcinomas: a survival evaluation based on a cohort of 7103 patients. figshare. Collection. https://doi.org/10.6084/m9.figshare.c.6069862.v1
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World Journal of Surgical Oncology

AUTHORS (24)

Yao Chen
Xue Ke Zhao
Rui Hua Xu
Xin Song
Miao Miao Yang
Fu You Zhou
Ling Ling Lei
Zong Min Fan
Xue Na Han
She Gan Gao
Xian Zeng Wang
Zhi Cai Liu
Ai Li Li
Wen Jun Gao
Jing Feng Hu
Li Guo Zhang
Jin Chang Wei
Fu Lin Jiao
Kan Zhong
Wei Peng Wang
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