Objective To investigate the clinical efficacy of radical gastrectomy with mesan-gientization via the inferior margin of the pancreas approach (GMIP).

Methods The retrospective cohort study was conducted. The clinicopathological data of 255 patients of Siewert Ⅱ and (or) Ⅲ adenocarcinoma of esophagogastric junction (AEG) who were admitted to Cancer Hospital Affiliated to Shanxi Medical University from March 2024 to March 2025 were collected. There were 191 males and 64 females, aged (62$\pm$7)years. Of 255 patients, 152 cases undergoing GMIP were allocated into the mesangientization radical resection group, 103 cases undergoing D₂ radical resection of gastric cancer were allocated into D₂ radical resection group. Observation indicators: (1) surgical and post-operative situations; (2) lymph node dissection status. Comparison of measurement data with normal distribution between groups was conducted using the t test. Comparison of measurement data with skewed distribution between groups was conducted using the Wilcoxon test. Comparison of count data between groups was conducted using the chi‑square test or corrected chi‑square test. Compari-son of ordinal data was conducted using the rank sum test.

Results (1) Surgical and postoperative situations. In the mesangientization radical resection group, the time of lymph node dissection was (115±14)minutes, volume of intraoperative blood loss was (81±37)mL. In the D₂ radical resection group, the above indicators were (97±13)minutes, (104±39)mL, respectively. There were significant differences in the above indicators between the two groups (t=-8.68, -4.64, P<0.05). In the mesan-gientization radical resection group, the total number of examined lymph node was 40.00(10.00), the number of lymph node dissected (the total number of each group) was 29.00(5.00), the number of lymph node metastasis (the total number of each group) was 2.00(1.00). In the D₂ radical resection group, the above indicators were 27.00(9.00), 8.00(4.00), 1.00(1.00), respec-tively. There were significant differences in the above indicators between the two groups (Z=-10.68, -13.57, -6.80, P<0.05). (3) Lymph node dissection status. There were significant differences in number of lymph node dissected of No.14v, 12a, 12p, 11d, 11p, 10, postgastric, 9, 8a, 8p lymph node between the mesangientization radical resection group and the D₂ radical resection group (P<0.05). There were significant differences in number of lymph node metastasis of No.11d and postgastric lymph node between the mesangientization radical resection group and the D₂ radical resection group (P<0.05).

Conclusion Compared with D₂ radical resection, the GMIP for Siewert Ⅱ or Ⅲ AEG has less volume of intraoperative blood loss and more complete lymph node dissection.