Abstract:
Background The incidence of adenocarcinoma of esophagogastric junction increases around the world. At present, there are few studies reporting robot-assisted treatment of Siewert type Ⅱ/Ⅲ adenocarcinoma of esophagogastric junction. Understanding the associated factors that affect the patients' postoperative prognosis will improve the postoperative survival.
Objective To compare the short-term and long-term outcomes of robotic versus laparoscopic treatment of Siewert type Ⅱ/Ⅲ adenocarcinoma of esophagogastric junction.
Methods A retrospective analysis was performed to the medical records of 111 patients with Siewert Type Ⅱ/Ⅲ adenocarcinoma of esophagogastric junction admitted to the Department of General Surgery Ⅱ, the First Medical Center of Chinese PLA General Hospital from January 2014 to August 2019. The patients were divided into robotic group (n=50) and laparoscopic group (n=61). The clinicopathological data and perioperative variables of the two groups were analyzed and compared. Follow-up was mainly by telephone, text message, and outpatient service to obtain the survival status of patients. The Kaplan-Meier analysis and log-rank test were used to analyze the survival of patients, and the Cox regression model was applied for univariate and multivariate analysis of the factors associated with prognosis.
Results There was no significant difference in the clinicopathological data between the two groups (P＞0.05). Compared with the laparoscopic group, the operating time was longer in the robotic group (231.7 ± 43.2 min vs 192.1 ± 44.0 min, P＜0.001), but the time to remove gastric tube was shorter (7.1 ± 1.4 days vs 8.5 ± 2.9 days, P=0.001). No significant difference was found in the number of lymph node excised, intraoperative blood loss, distance from the tumor to the distal resection margin, intestinal function recovery time, postoperative hospital stay and postoperative complication rate (P＞0.05). The robotic group and the laparoscopic group had similar 3-year survival rate (79.5% vs 73.0%) and disease-free survival rate (DFS) (74.1% vs 65.4%)(P＞0.05). Siewert type of tumor (HR: 2.605, 95% CI: 1.805-6.255), T stage (HR: 3.075, 95% CI: 1.408-6.714), N stage (HR: 2.060, 95% CI: 1.206-4.303), positive margin (HR: 4.258, 95% CI: 1.245-14.562) were independently associated with DFS. Age (HR: 4.178, 95% CI: 1.394-12.524), TNM stage (HR: 2.568, 95% CI: 1.009-6.539), tumor size (HR: 3.504, 95% CI: 1.254-9.791) were independently associated with overall survival.
Conclusion Robotic treatment has similar effect with laparoscopic-assisted treatment for Siewert Ⅱ/Ⅲ adenocarcinoma of the esophagogastric junction. Surgeons should combine treatment with risk factors affecting patients' postoperative outcomes to improve their long-term prognosis.
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