Comparison of factors and prognosis in transthoracic vs. transthoracic-abdominal surgery for EGJA

Background : Esophagogastric junction adenocarcinoma (EGJA) is a malignant tumor with special location and complex condition, mainly occurring at the junction of esophagus and stomach. With the increasing incidence, its surgical treatment has attracted wide attention. At present, the mainstream surgical methods include transthoracic surgery (TET) and transthoracic combined surgery (TAT), and there are significant differences between the two in terms ofoperation path, postoperative recovery and prognosis. The purpose of this study is to retrospectively analyze the therapeutic effect and prognosis of EGJA patients with two surgical methods, in order to provide valuable reference for clinical decision-making. METHODS : The clinical data of 148 patients with EGJA treated by transthoracic (80 cases)or transthoracic (68 cases) operation in our hospital from 2016 to 2018 were collected.. The Kaplan–Meier method and the log-rank test were used for univariate survival analysis. Cox regression model was used for multivariate survival analysis. RESULTS : This study identified gender, neoadjuvant chemotherapy, adjuvant chemotherapy, and T stage as significant prognostic factors influencing overall survival (OS) and disease-free survival (DFS). Transthoracic surgery was associated with a longer operative time (188 vs. 155 minutes, P<0.001), a greater number of dissected lymph nodes (24 vs. 22), and an increased number of positive lymph nodes (3 vs. 2, P=0.022), particularly in type II patients (4 vs. 2, P=0.029). For type I patients, overall survival (OS) rates were 52. 1% for the thoracoabdominal surgery group compared to 53. 1% for the transthoracic surgery group, while disease-free survival (DFS) rates were 41.0% and 65.7%, respectively. However, these differences were not statistically significant. In type II patients, although transthoracic surgery is associated with a longer surgical duration, this does not impact the length of hospital stay or intraoperative blood loss. Furthermore, due to its capacity to dissect a greater number of positive lymph nodes, transthoracic surgery may be more effective in reducing tumor residue. Notably, patients undergoing thoracoabdominal surgery experienced a significant improvement in OS (42% vs. 9.3%, P=0.035), although the change in DFS was not statistically significant (35.4%vs. 21.7%). Conclusions : Patients classified as Type I may be more appropriate candidates for transthoracic surgery, given its shorter operation time. In contrast, both transthoracic and abdominal surgeries may represent more suitable surgical options for Type II patients.