Comparison Of The Effect Of Different Surgical Approaches On The Treatment Of Siewert Type Ⅱ Esophagogastric Junction Adenocarcinoma By Proximal Gastrectomy

Objective To compare and analyze the clinical efficacy of the proximal gastrectomy for Siewert type Ⅱ esophagogastric junction adenocarcinoma by transthoracic and transabdominal surgery.Methods A retrospective analysis of 75 patients with Siewert type II AEG who underwent proximal gastrectomy in Anhui Provincial Hospital from September 2015 to December 2017.According to the different surgical approaches,they were divided into48 cases in the transthoracic group and 27 cases in the transabdominal group.Through the collection of clinical data and postoperative follow-up data,the intraoperative situation,perioperative complications,postoperative survival rate and postoperative quality of life of the two groups were compared.Results There was no significant difference between the two groups of patients in terms of gender,age,tumor size,tumor differentiation,and TNM staging(P>0.05).In terms of lymph node dissection,the number of thoracic lymph nodes dissected in the transthoracic approach group was more,and the difference was statistically significant(P<0.001);the number of abdominal lymph nodes dissected in the abdominal approach group was more,and the difference was statistically significant(P=0.006).However,there was no significant difference in the positive rate of lymph nodes and the number of positive lymph node stations between the two groups of patients(P>0.05).There was no significant difference in operation time and intraoperative blood loss between the two groups(P>0.05).In the transabdominal group,the drainage volume at 3 days,the drainage volume at 7 days,total drainage volume,time to get out of bed,postoperative hospital stay,and total hospitalization expenses were lower than those in the transthoracic group,the difference was statistically significant(P<0.001).Arrhythmia,pulmonary infection,atelectasis,pleural effusion,abdominal infection,incision infection,chyle leakage,anastomotic leakage,and anastomotic stenosis were not statistically different between the two groups of patients in single complications(P>0.05);There were more pulmonary complications in the thoracic group than in the transabdominal group,and the difference was statistically significant(P=0.038).The1-year survival rate of the transthoracic group was 83.3%,and the 3-year survival rate was 43.7%;the 1-year survival rate of the transabdominal group was 74.1%,and the3-year survival rate was 37.0%.The Log-Rank test showed that there was no statistically significant difference in the 1-year survival rate,3-year survival rate and overall average survival rate between the two groups(P=0.364).There was no significant difference in the quality of life between the two groups of patients before surgery(p>0.05).The quality of life of the transthoracic group and the transabdominal group decreased after the operation,and it dropped to the lowest one month after the operation,and then gradually increased,and it did not return to the preoperative level until 6 months after the operation.At 1,3,and 6 months after surgery,the scores of the transthoracic group in terms of overall health status,physical function,emotional function,and social function were higher than those of the transabdominal group,and the difference was statistically significant(P<0.001);nausea,vomiting,loss of appetite,The score of reflux symptoms in the transthoracic group was lower than that of the transabdominal group,and the difference was statistically significant(P<0.001);the pain score of the transabdominal group was lower than that of the transthoracic group,and the difference was statistically significant(P < 0.001).There was no significant difference in the scores between the two groups in terms of role function,cognitive function,fatigue,shortness of breath,insomnia,constipation,diarrhea,and financial difficulties(p>0.05).Conclusion The transthoracic approach group is better than the transabdominal approach in terms of esophagus resection,thoracic lymph node dissection and overall quality of life;the transabdominal approach group has fewer postoperative complications,less trauma,and has more advantages in abdominal lymph node dissection.