Comparison Of Short-term And Long-term Outcomes Following Minimally Invasive Vs. Open Sweet Esophagectomy For Adenocarcinoma Of The Esophagogastric Junction

Background:Adenocarcinoma of the esophagogastric junction refers to tumors located within 5cm above and below the Esophagogastric junction（EGJ）,which accounts for more than one third of all esophageal and gastric adenocarcinomas in western countries.At present,the clinical treatment is mainly based on surgery.Siewert type I and III AEG surgical methods have been approved by the expert group,while Siewert II AEG surgical methods have not been unified.General surgeons prefer transabdominal approach,while thoracic surgeons mostly adopt transthoracic approach.Among them,the traditional left transthoracic approach（Open Sweet Esophagectomy,OSE）is most widely used in thoracic surgeons,but it has disadvantages such as large surgical trauma and slow postoperative recovery.With the development of minimally invasive surgery,minimally invasive Sweet esophagectomy（MISE）has been gradually applied in clinical practice in recent years.Studies have confirmed that it has less trauma,lower incidence of postoperative complications and faster recovery for patients,but there has no corresponding report on its long-term efficacy,Therefore,this paper mainly discusses the effect of minimally invasive and open Sweet esophagectomy on the short-term and long-term prognosis of Siewert II esophagogastric junction adenocarcinoma.Methods: 137 cases of Siewert type II esophagogastric junction adenocarcinoma treated in our hospital from March 2015 to September 2017 were collected retrospectively.38 cases underwent MISE and 99 cases underwent OSE.In general clinicopathological features,intraoperative general situation,the total number of lymph node dissections,the number of positive lymph nodes,and perioperative complications,the classified variables were expressed as frequency（percentage）,continuous variables were expressed as mean ± standard deviation（X±S）.Chi-square test（or Fisher’s exact probability method）and T-test were used to compare categorical variables and continuous variables,respectively,and rank data were compared by Mann Whitney test.The survival curve was drawn by Kaplan Meier method,and the survival difference between groups was analyzed by log rank test.The variables with P<0.05 in univariate analysis were included in Cox multivariate analysis.Results: A total of 137 patients were collected,including 106 males and 31 females.The average age was（66.12±8.39）years.There were 38 cases in the MISE group and99 cases in the OSE group.The general data of the two groups were comparable.The amount of surgical bleeding in the MISE group was less than that in the OSE group（119.74±45.82 vs 147.47±74.36 ml,P=0.034）.The total number of lymph node dissections and the number of abdominal lymph node dissections were better than OSE,but the operation time was longer than that in the OSE group（249.58±59.43 vs196.78±52.86 min,P<0.001）.Among all complications,pulmonary infection was the most common,with a total of 26 cases（57.78%）.The incidence of pulmonary infection in the MISE group was lower than that in the OSE group,and there was no significant difference.The incidence of grade 2-3 complications in OSE group was higher than that in MISE group,and the postoperative hospital stay was longer than that in MISE group（P<0.05）.There was no significant difference in recurrence,metastasis and 3-year survival rate between groups（68% in mise group vs 58% in ose group,P=0.575）.The3-year survival rates of all patients,the MISE group and OSE group were 62.0%,68.4%and 59.6% respectively.There was no significant difference between two groups（P=0.384）.A total of 43 patients had recurrence or metastasis within three years.The total metastasis rate was 23.68% in the MISE group and 30.30% in the OSE group（P>0.05）;The recurrence rate of anastomotic stoma was 5.26% in MISE group and2.02% in OSE group;The incidence of abdominal lymph node metastasis was the highest（7.89% in MISE group vs 10.10% in OSE group,P=0.945）,followed by liver metastasis（5.26% in MISE group vs 7.07% in OSE group,P=1.000）.Multivariate analysis showed that when N0 stage was used as a reference,N3 stage was an independent adverse risk factor affecting the long-term survival of patients.Conclusion:The short-term effect of MISE was better than that of OSE,which was conducive to the rapid recovery of patients,but it can’t improve the long-term prognosis.In addition,relative to N0 stage,N3 stage was an independent risk factor for prognosis.