Comparison of three digestive tract reconstruction methods for the treatment of Siewert II and III adenocarcinoma of esophagogastric junction: a prospective, randomized controlled study.
BACKGROUND
The incidence of adenocarcinoma of esophagogastric junction (AEG) has recently risen worldwide, including in Eastern Asia. The aim of the study was to explore the short-term and long-term clinical efficacy of piggyback jejunal interposition reconstruction single-tract reconstruction (PJIRSTR), piggyback jejunal interposition reconstruction double-tract reconstruction (PJIRDTR), and total gastrectomy esophageal jejunal Roux-en-Y anastomosis (TGRY) for the treatment of Siewert II and III AEG patients.


METHODS
A total of 300 Siewert II and III AEG patients admitted to Shanxi Tumor Hospital from June 2015 to December 2017 were prospectively selected. Patients were randomly divided into PJIRSTR group (n = 98), PJIRDTR group (n = 103), and TGRY group (n = 99) using the random number table method.


RESULTS
There were no statistically significant differences in total operation time, intraoperative blood loss, time of first anal exhaust, and postoperative hospital stay among the three groups (F = 2.526, 0.457, 0.234, 0.453; P > 0.05). The reconstruction time of PJIRSTR group and PJIRDTR group was longer than that of TGRY group (P < 0.01). There were no significant differences in cases of anastomotic leakage, anastomotic bleeding, abdominal infection, incision infection, ileus, and dumping syndrome in three groups (P > 0.05). The incidence of reflux esophagitis at 3, 6, 12, and 18 months after surgery in the PJIRSTR group and the PJIRDTR group were significantly lower than TGRY group in the same period (P < 0.05). Compared with PJIRDTR group and TGRY group, PJIRSTR group had a small fluctuation range of postoperative nutrition indexes and had basically recovered to the preoperative level at 18 months. Four patients of Visick grade IV presented in TGRY group 18 months postoperatively, which was significantly higher compared with the other two groups.


CONCLUSION
Compared with PJIRDTR and TGRY, PJIRSTR can significantly reduce the incidence of postoperative reflux esophagitis and improve the long-term nutritional status of patients.


TRIAL REGISTRATION
Chinese Clinical Trial Registry, ChiCTR-IIR-16007733. Registered 07 November 2015 - Retrospectively registered, http://www.chictr.org.cn/searchproj.aspx.
['Li|Zhiguo|Z|', 'Dong|Jianhong|J|', 'Huang|Qingxing|Q|', 'Zhang|Wanhong|W|', 'Tao|Kai|K|']
D000230:Adenocarcinoma D000328:Adult D000368:Aged D000369:Aged, 80 and over D000713:Anastomosis, Roux-en-Y D000714:Anastomosis, Surgical D013505:Digestive System Surgical Procedures D004938:Esophageal Neoplasms D004943:Esophagogastric Junction D005260:Female D005500:Follow-Up Studies D006801:Humans D008297:Male D008875:Middle Aged D061646:Operative Time D011379:Prognosis D011446:Prospective Studies D019651:Reconstructive Surgical Procedures D013274:Stomach Neoplasms
Piggyback jejunal interposition reconstruction single-tract reconstruction Piggyback jejunal interposition reconstruction double-tract reconstruction Total gastrectomy esophageal jejunal Roux-en-Y anastomosis Reflux esophagitis