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Transthoracic, thoracoabdominal, and transabdominal surgical approaches for gastric cardia adenocarcinomas: a survival evaluation based on a cohort of 7103 patients
Journal article   Open access   Peer reviewed

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

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, …
World journal of surgical oncology, v 20(1), pp 1-217
28 Jun 2022
DOI: https://doi.org/10.1186/s12957-022-02680-5
PMID: 35764996
Featured in Collection :   UN Sustainable Development Goals @ Drexel
url
https://wjso.biomedcentral.com/counter/pdf/10.1186/s12957-022-02680-5View
Published, Version of Record (VoR) Open
url
https://doi.org/10.1186/s12957-022-02680-5View
Published, Version of Record (VoR) Open

Abstract

Life Sciences & Biomedicine Oncology Science & Technology Surgery
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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9 citations in Scopus

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Collaboration types
Domestic collaboration
Web of Science research areas
Oncology
Surgery
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