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

作者：Yao Chen, Xue Zhao, Rui‐Hua Xu, Xin Song, Miao Miao Yang, Fu You Zhou, Ling Ling Lei, Zong Min Fan, Xue Han, She Gan Gao, Xian Zeng Wang, Zhi Cai Liu, Ai Li Li, Wen Gao, Jing Feng Hu, Li Guo Zhang, Wei Jin, Fu Lin Jiao, Kan Zhong, Wei Peng Wang, Liu Yu Li, Jia Jia Ji, Xue Min Li, Lidong Wang · 发表于：World Journal of Surgical Oncology · 年份：2022 · DOI：10.1186/s12957-022-02680-5 · 被引用次数：20 · 研究领域：Esophageal Cancer Research and Treatment、Gastric Cancer Management and Outcomes、Gastrointestinal Tumor Research and Treatment

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 signif...