ArticleCancer management and research2025
Investigating the Effects of Different Lengths of Proximal Margin for Siewert Type II and Type III Adenocarcinoma of Esophagogastric Junction on Short- and Long-Term Prognosis.
Article in Cancer management and research, 2025. The graph could read no effect estimate from its abstract, so it casts no vote on the map. Not yet cited in PubMed.
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Abstract
Introduction: The optimal proximal margin length for Siewert type II/III adenocarcinoma of the esophagogastric junction (AEJ) remains debated. This study aimed to evaluate the effect of different proximal margin lengths on short- and long-term prognosis. Methods: In this retrospective study, clinical data from patients undergoing surgery for Siewert type II/III AEJ between January 2019 and January 2024 were collected. Patients were stratified into three groups based on the length of the proximal margin (0.5-2 cm, 2-4 cm, and >4 cm). Short-term outcomes, including R0 resection rates and complications, along with long-term survival (OS and PFS), were evaluated. Kaplan-Meier survival analysis and Cox proportional hazards regression models were employed to assess prognostic impacts. Results: A total of 173 patients were included (0.5-2 cm, n=57; 2-4 cm, n=60; >4 cm, n=56). The 0.5-2 cm group had significantly higher R1 resection (12.28% vs 1.67%/0%) and anastomotic recurrence rates but a lower anastomotic leak incidence compared to the other groups (P<0.05). The >4 cm group showed longer operative times and higher leak rates. Survival analysis revealed poorer overall survival (OS) and progression-free survival (PFS) for the 0.5-2 cm group versus other groups (P<0.05), with no significant difference between the 2-4 cm and >4 cm groups. Cox regression confirmed that a margin length >2 cm reduced progression risk (HR=0.793, 95% CI 0.641-0.981, P=0.033), particularly for tumors <4 cm, Siewert type II, and intestinal-type Lauren classification. Conclusion: A 2-4 cm proximal margin appears to optimize the prognosis in Siewert type II/III AEJ, balancing oncologic safety and surgical outcomes. This margin length is especially beneficial for tumors <4 cm, Siewert II classification, and intestinal-type histology. A personalized surgical strategy is recommended.
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