Abstract： Objective To compare clinical outcomes and postoperative quality of life （QOL） of difference surgical strategies for patients with esophagogastric junction （EGJ） cancer， and investigate the best surgical strategy. Methods A total of 148 patients with EGJ cancer underwent surgical treatment in Xuzhou First People’s Hospital from July 2007 to October 2011. There were 111 male patients and 37 female patients with an average age of 64 （47-77）years. All the patients were divided into 3 groups according to different surgical strategies for them based on their respective preoperative assessment and tumor invasion degree. In group A， 81 patients underwent proximal subtotal gastrectomy and subaortic gastroesophageal anastomosis. In group B， 20 patients underwent total gastrectomy and esophagojejunostomy. In group C， 47 patients underwent proximal subtotal gastrectomy and jejunal interposition. Postoperative mortality and morbidity were compared among the three groups. Cancer metastasis rate and 1-year survival rate were also compared among the three groups. QOL questionnaire （EORTC QLQ C-30 and tumor specific module QLQ-OES24） was used to evaluate patients’ QOL during follow-up. Results There was no statistical difference in postoperative morbidity （P=0.762）and mortality （P=0.650）among the three groups. There was no statistical difference in cancer metastasis rate at 1 year after surgery among the three groups （P=0.983）. One-year survival rate was 100% in all the three groups. At 1 year after surgery， physical functioning score （P=0.037，0.000） and global health score （P=0.035，0.006） of group A and group C were significantly higher than those of group B， and there was no statistical difference in physical functioning score and global health score between group A and group C （P＞0.05）. Emotional function score of group B was significantly lower than that of group C （P=0.015）. Fatigue score （P=0.040，0.006）， anorexia（P=0.045，0.025）， nausea and vomiting symptom score （P=0.033，0.048） of group A and group C were significantly lower than those of group B. Pain score of group A was significantly lower than that of group C （P=0.009）. Insomnia score of group A was significantly higher than that of group C （P=0.028）. Reflux score of group A was significantly higher than that of group B and group C （P=0.025，P=0.021）. Conclusion Postoperative QOL in patients with EGJ cancer who undergo total gastrectomy is comparatively unsatisfactory. Proximal subtotal gastrectomy and jejunal interposition can significantly improve postoperative QOL. Postoperative QOL evaluation is helpful to choose better surgical strategies for patients with EGJ cancer.
Objective To analyze the influencing factors for postoperative anastomotic leak (AL) in carcinoma of the esophagus and gastroesophageal junction and construct a nomogram predictive model. Methods The patients who underwent radical esophagectomy at Jinling Hospital Affiliated to Nanjing University School of Medicine from January 2018 to June 2020 were included in this study. Relevant variables were screened using univariate and multivariate logistic regression analyses. A nomogram was then developed to predict the risk factors associated with postoperative AL. The predictive performance of the nomogram was validated using the receiver operating characteristic (ROC) curve. Results A total of 468 patients with carcinoma of the esophagus and gastroesophageal junction were included in the study, comprising 354 males and 114 females, with a mean age of (62.8±7.2) years. The tumors were predominantly located in the middle or lower esophagus, and 51 (10.90%) patients experienced postoperative AL. Univariate logistic regression analysis indicated that age, body mass index (BMI), tumor location, preoperative albumin levels, diabetes mellitus, anastomosis technique, anastomosis site, and C-reactive protein (CRP) levels were potentially associated with AL (P<0.05). Multivariate logistic regression analysis identified age, BMI, tumor location, diabetes mellitus, anastomosis technique, and CRP levels as independent risk factors for AL (P<0.05). A nomogram was developed based on the findings from the multivariate logistic regression analysis. The area under the receiver operating characteristic (ROC) curve was 0.803, indicating a strong concordance between the actual observations and the predicted outcomes. Furthermore, decision curve analysis demonstrated that the newly established nomogram holds significant value for clinical decision-making. Conclusion The predictive model for postoperative AL in patients with carcinoma of the esophagus and gastroesophageal junction demonstrates strong predictive validity and is essential for guiding clinical monitoring, early detection, and preventive strategies.