Gastrectomy with either wedge resection of the pancreas or pancreaticosplenectomy for adenocarcinoma of the esophagogastric junction invading the pancreas: a comparison study
10.3760/cma.j.issn.0529-5815.2019.06.011
- VernacularTitle: 胃切除联合根治性胰体尾和脾切除或联合姑息性胰腺楔形切除治疗侵犯胰腺的食管胃交界部腺癌的效果比较
- Author:
Junfeng LIU
1
;
Xinbo LIU
;
Zhe WANG
;
Zhihua SHI
;
Bingji CAO
;
Tao JIANG
;
Shaowei ZHANG
Author Information
1. Department of Thoracic Surgery, Fourth Hospital, Hebei Medical University, Shijiazhuang 050011, China
- Publication Type:Journal Article
- Keywords:
Esophageal neoplasms;
Pancreatectomy;
Splenectomy;
Antineoplastic combined chemotherapy protocols
- From:
Chinese Journal of Surgery
2019;57(6):452-456
- CountryChina
- Language:Chinese
-
Abstract:
Objective:To compare the outcomes of gastrectomy with either wedge resection of the pancreas or pancreaticosplenectomy for adenocarcinoma of the esophagogastric junction (AEG) invading pancreas.
Methods:From May 2005 to December 2015, a total of 64 patients with AEG invading pancreas underwent gastrectomy with either wedge resection of pancreas (n=25) or pancreaticosplenectomy (n=39) at Department of Thoracic Surgery, Fourth Hospital, Hebei Medical University. There were 53 males and 11 females, with a mean age of 60.2 years (range: 39 to 77 years). According to the AJCC esophageal cancer staging system, 8th edition, there were 27 patients in phase T4N0M0, 18 in phase T4bN1M0, 9 in phase T4bN2M0 and 10 in phase T4bN3M0. Follow-up was carried out every 6 months. The t-test for the measurement data and the χ2 test, Fisher exact test or Wilcoxon ran-sum test for the enumeration data were used between the two groups. Survival curves were generated using the Kaplan-Meier method, and compared using the Log-rank test. Multivariate analysis was undertaken using the Cox proportional hazard model (forward stepwise regression).
Results:In 39 patients who underwent pancreaticosplenectomy, incision infection occurred in 5 patients, anastomotic leak, peritoneal infection, lung infarction each occurred in 1 patient. There was 1 respiratory failure and 1 peritoneal infection in 25 patients undergoing wedge resection of the pancreas. There were no significant difference in the incidence of postoperative complications between the 2 groups (8/39 vs. 2/25, P=0.292), and no postoperative death in the study. Fifty-seven patients were followed up, with a follow-up rate of 89.1%. The 5-year overall survival rate was 32.3% in patients who underwent simultaneous gastrectomy and pancreaticosplenectomy, compared to 0 in those who underwent gastrectomy and wedge resection of the pancreas (χ2=4.484, P=0.034). The 5-year overall survival rate for patients who undergoing adjuvant chemotherapy was 32.3%, compared to 17.2% in whom underwent surgery alone (χ2=4.186, P=0.041).
Conclusions:Survival benefit from R0 resection by simultaneous gastrectomy and pancreaticosplenectomy for AEG invading the pancreas can be achieved. Adjuvant chemotherapy is necessary for these patients.
