Comparison Of Safety And Survival Of Different Surgical Approaches In The Treatment Of Siewert Type Ⅱ Adenocarcinoma Of Esophagogastric Junction

Background and purposeThe incidence of AEG has been rising in recent years.Surgery therapy is still major treatment of AEG.The Siewert definition of AEG facilitates decision of surgical approach and there are still many controversies about surgical approaches for patients with Siewert type Ⅱ adenocarcinoma of esophagogastric junction.This article intends to compare the safety and survival of different surgical approaches in the treatment of Siewert type Ⅱ Adenocarcinoma of esophagogastric junction,which can help to select more suitable surgical approach for Siewert Ⅱ AEG.Data and Method183cases of patients diagnosed as adenocarcinoma of gastroesophageal junction,Siewert Ⅱ type and underwent radical resection of cancer at the Department of gastrointestinal surgery and department of thoracic surgery of our hospital between 1st Jan.,2013 and 31 st Dec.,2015 were selected.According to partial lymph node metastasis and the differences of operative approaches,they were divided into four group:transabdominal approach without lymph node metastasis group,transthoracic approach without lymph node metastasis group,transabdominal approach with lymph node metastasis group and transthoracic approach with lymph node metastasis group.The data of transabdominal group without lymph node metastasis group and transthoracic group without lymph node metastasis group were compared,and the clinical data of transabdominal lymph node metastasis group and transthoracic lymph node metastasis group were compared.The observation indicators included surgical radical extent,intraoperative bleeding volume,surgical duration,perioperative complications,postoperative hospital stay and survival rate etc.ResultThere were altogether 183 cases of patients with adenocarcinoma of gastroesophageal junction included in this study,among which 148 male cases and 35 female cases,the gender ratio was 4.23:1.(2)The transabdominal group without lymph node metastasis group and transthoracic group without lymph node metastasis group had no significant.difference in aspects of age,gender,tumor T phase and histological grading(P>0.05).And it is same to lymph node metastasis group.(3)No matter in the without lymph node metastasis group or in the lymph node metastasis group,there had no obvious difference in the surgical duration and positive rate of upper and lower cutting-edge between transabdominal route group and transthoracic group;As to the intraoperative bleeding volume,the transabdominal route group were apparently fewer than that of transthoracic group.While in terms of mean lymph node dissection,the transabdominal route group were apparently more than that of transthoracic group,the difference were statistically significant.However,the average number of positive lymph nodes in the transthoracic group was higher than that in the transabdominal group(4)The gross postoperative complication rate,the incidence rate of chest-related complication and the postoperative hospital stay in the transabdominal group were lower than that of transthoracic group,the differences were statistically significant.While the abdominal infection,surgical incision infection,severe complication and the incidence rate of anastomotic stoma complications between the groups had no apparent difference.(5)Conclusions for the first,second,and third year survival rates in the non-lymph node metastatic group: the routing group was higher than the transthoracic route,with no statistically significant difference between the 1-year survival rates(P > 0.05)and the second and third year survival rates(P $lt;0.05).The 1-year and 2-year survival rate of the transabdominal group was slightly higher than that of the transthoracic group,and the 3-year survival rate was slightly lower than that of the transthoracic group,with no statistically significant difference(P>0.05).ConclusionIn conclusion,in aspect of surgical route selection for adenocarcinoma of gastroesophageal junction patients with Siewert Ⅱ type:1.The transabdominal route group had less postoperative complications and trauma than transthoracic route group.2.In the without lymph node metastasis group,the survival rate of the transabdominal route group were higher than that of transthoracic route group.3.As a whole,the transabdominal route is superior to the transthoracic route.