Perioperative Period And Long-term Survival Of Adenocarcinoma Of Esophagogastric Junction Treated By Different Surgical Approaches Clinical Study

Objective By comparing the clinical data between the left thoracotomy approach and the transabdominal esophagogastric hiatal approach,we investigated the surgical related indexes and postoperative pathology and complications between the two groups,and thus explored the safety and long-term outcomes of treating patients with Siewert’s type Ⅱ adenocarcinoma of the esophagogastric junction(AEG)during the perioperative period.Methods A retrospective study was conducted in 307 complete cases of AEG of Siewert type Ⅱ confirmed by clinical pathology after operation,which were admitted to XX Medical University from January 2013 to December 2017.According to the different surgical paths,the patients were divided into a left thoracic approach group and received "left thoracotomy+radical resection of cardiac cancer+mechanical esophagogastrostomy".A total of 170 cases in the transabdominal hiatus approach group were treated with "exploratory laparotomy+radical resection of cardiac cancer+proximal gastrectomy";The general data,intraoperative conditions,postoperative pathology,and complications between the group that underwent a left thoracotomy and the group that underwent a transabdominal hiatal approach were compared.Data analysis was performed with SPSS 25.0.Results After the inclusion and exclusion criteria,a total of 137 and 170 cases in the left thoracotomy and transabdominal esophagogastric hiatus approaches,respectively,were included in this study,for a total of 307 patients with complete clinicopathological data of Siewert type Ⅱ AEG.The results of the study showed that:(1)The length of hospital stay was25.3 ± 9.0 days and 23.4 ± 6.6 days in the group that underwent left thoracotomy and esophagectomy,respectively,and the number of positive lymph nodes was higher in the group that underwent transabdominal esophagectomy than in the group that underwent left thoracotomy(P < 0.05).(2)the number of positive lymph nodes was 4.0 ± 5.3 in the group that underwent left versus transabdominal esophagectomy and2.7 ± 4.5 cases,and the former had a worse stage in terms of Pt stage,PN stage(P < 0.05).The tumor diameters of the two groups were 4.6 ± 2.0 cm and 3.8 ± 2.2 cm,respectively.The tumor diameters of the patients in the transthoracic group were relatively larger;there was a statistical difference between the surgical modalities(P < 0.05);(3)Pulmonary infection was the predominant complication in17.9% of patients,anastomotic leak in 3.58% of patients,and death within 30 days after surgery in 5 and 1 patients,respectively.(4)univariate analysis found that tumor diameter,surgical approach,Pt stage,PN stage,and postoperative adjuvant chemotherapy were related to survival time,while multivariate analysis determined that tumor Pt and PN stage were related to Siewert type ⅡIndependent prognostic factors for AEG survival.(5)Kaplan Meier analysis found that the 1-year survival rate was 85.4%,the 3-year survival rate was 51.2%,and the 5-year survival rate was 41.2% in the left thoracotomy group and 85.3%,64.2%,and57.4% in the transabdominal esophagectomy group,respectively.In terms of 3-and 5-year survival rates,the transabdominal esophageal hiatus group was superior to the left thoracotomy group(P < 0.05).Conclusion(1)The transabdominal hiatal approach was superior to the left thoracotomy approach in terms of perioperative complications and hospital days.(2)Tumor Pt and PN stage are independent prognostic factors in adenocarcinomas of the esophagogastric junction.(3)Both surgical approaches are safe.Compared with the left thoracotomy group,the transabdominal esophagectomy group had a better prognosis and better safety profile.