Study on safety,efficacy and nutrition of proximal gastrectomy with SOFY versus total gastrectomy with Roux-en-Y for treating Siewert Ⅱ/Ⅲ adenocarcinoma of the esophagogastric junction

ZHANG Hai-qiao; WANG Xi; HUANG Yong; WANG Zi-meng; LI Jia-xuan; XUE Ya-sheng; ZHENG Zhi; LIU Xiao-ye; YIN Jie; ZHANG Jun

doi:10.19538/j.cjps.issn1005-2208.2025.02.12

Abstract：Objective To compare the safety,efficacy and nutrition of proximal gastrectomy(PG)with SOFY versus total gastrectomy(TG)with Roux-en-Y for treating Siewert Ⅱ/Ⅲ adenocarcinoma of the esophagogastric junction(AEG).Methods We used a bidirectional cohort study to analyze the clinical data of 154 Siewert Ⅱ/Ⅲ AEG patients treated at Beijing Friendship Hospital,Capital Medical University from March 2017 to June 2023.There were 66 cases in PG group and 88 cases in TG group.The main outcome was weight loss rate 1 year after surgery in both groups.Results The PG group showed significant advantages over the TG group in average operative time,intraoperative blood loss,time to pass gas,and time to liquid intake,with statistically significant differences(P＜0.05).Among the 119 cases that completed a one-year follow-up,there were 53 in the PG group and 66 in the TG group.The weight loss rates at 6 months(-10.6％vs.-14.0％)and at 1 year(-9.0％vs.-15.2％)were lower in the PG group compared to the TG group,with statistically significant differences(P＜0.05).The PG group had better outcomes regarding diarrhea and the degree of eating restriction at 1 year after surgery compared to the TG group.However,the TG group had a lower incidence of gastroesophageal reflux(9.1％vs.50.9％),better reflux symptom scores,and better overall health status at 1 year after surgery than the PG group,with statistically significant differences(P＜0.05).In the PG group,21 patients(39.6％)developed reflux esophagitis at 1 year after surgery,classified according to the Los Angeles classification(LA),13 cases at LA-A(61.9％),6 cases at LA-B(28.6％),and 2 cases at LA-C(9.5％),with no cases at LA-D.Conclusion In the surgical treatment of Siewert Ⅱ/Ⅲ AEG,PG(SOFY reconstruction)shows significant advantages over TG(Roux-en-Y reconstruction)in terms of surgical operation,perioperative recovery,and postoperative weight maintenance.However,TG has a notable advantage in postoperative quality of life.Additionally,the incidence of reflux esophagitis is higher after SOFY reconstruction,but most cases are classified as LA-A,and symptoms can be controlled with standard doses of PPI medication.