Comparative Study On The Short Term Efficacy Of Different Surgical Methods In The Treatment Of Gastric Adenocarcinoma Of Cardia

Background: Gastric cancer,as one of the top five cancers with mortality worldwide,has been a serious threat to human health.Since the 21 st century,the incidence of gastric cancer has been declining all over the world,which is mainly reflected in non-cardia gastric adenocarcinoma（NCGA）,but the incidence of cardia gastric adenocarcinoma（CGA）is increasing instead of decreasing.Therefore,the precise treatment of CGA has become an urgent problem to be solved.As one of the key ways to treat CGA,surgical treatment has always been the focus of clinicians’ attention.In the past,traditional open gastrectomy（OG）has always been the standard operation for the treatment of CGA,but the birth of minimally invasive surgery and the emergence of laparoscopic technology have greatly reduced the pain of patients.Laparoscopic-assisted gastrectomy（LAG）was performed in the early stages of laparoscopic gastrectomy,mainly assisted by small incisions and in vitro reconstruction of the digestive tract.With the emergence and progress of mechanical anastomosis technology,the surgeon’s proficiency increases,and the implementation of complete laparoscopic anastomosis becomes possible,thus the birth of complete laparoscopic gastrectomy（TLG）.Currently,the short-term efficacy and long-term prognosis of TLG in the treatment of NCGA have been unanimously recognized by people,but the effect of TLG in the treatment of CGA is still unclear,and the surgical choice of CGA patients is still controversial.Objective: This paper aims to retrospectively analyze the case data of CGA patients in our center,to discuss and study the short-term efficacy of three different surgical methods（OG,LAG and TLG）in the treatment of CGA,and to explore the optimal surgical method for CGA patients.Methods: A retrospective study was conducted to collect 153 patients with gastric adenocarcinoma of cardia undergoing radical gastrectomy for D2 from September 2019 to December 2021 in our department.The operative indicators,postoperative recovery and incidence of complications of CGA patients treated by three surgical methods were analyzed.SPSS 25.0 statistical software was used to analyze the efficacy of different surgical methods.Results: The 153 patients（110 males,43 females,male to female ratio 2.56:1）were divided into three groups: 63 in OG group,43 in LAG group,and 47 in TLG group.Chi-square test was χ2=0.109,P > 0.05,indicating no statistically significant difference between the three groups.There were no significant differences in age,BMI,maximum tumor diameter and TNM stage among the three groups（P > 0.05）.Among the operator-related indicators,the operative time of patients in the TLG group（260.21±42.77min）,the LAG group（250.44±36.98min）and the OG group（198.35±23.74min）were statistically significant（P < 0.05）.There was no significant difference between the TLG group and the LAG group（P > 0.05）,but there were significant differences between the TLG group and the OG group,and between the LAG group and the OG group（P < 0.05）.In terms of intraoperative blood loss,TLG group（69.77±25.13ml）,LAG group（133.26±32.10ml）,OG group（203.08±37.65ml）and incision length,TLG group（4.64±1.07cm）,LAG group（9.95±1.54cm）,OG group（19.90）±2.41cm),and there were statistically significant differences among the three groups（P < 0.05）.In pairwise comparison among the three groups,there were statistically significant differences between the TLG group and the LAG group,the TLG group and the OG group,and the LAG group and the OG group（P < 0.05）.There was no statistical difference in the number of dissected lymph nodes and the number of positive lymph nodes among the three groups.（P > 0.05）.In postoperative recovery indicators,there were statistically significant differences among the three groups in 24 h postoperative pain score,gastric tube extraction time,liquid diet time and total cost（P < 0.05）.In pair comparison,there were statistically significant differences between the TLG group and the LAG group,the TLG group and the OG group,and the LAG group and the OG group（P < 0.05）.There were statistically significant differences in the first postoperative time to get out of bed,exhaust,drainage tube removal time and hospital stay after surgery（P < 0.05）,but there were no statistically significant differences between the TLG group and the LAG group（P >0.05）,and there were statistically significant differences between the TLG group and the OG group,and between the LAG group and the OG group（P < 0.05）.Among postoperative complications,there was no statistically significant difference in the overall incidence of complications among the three groups（P > 0.05）,among which,the incidence of anastomotic fistula was 4.26%（2/47）in the TLG group,2.33%（1/43）in the LAG group,and 1.59%（1/63）in the OG group.There was no significant difference（P > 0.05）.The complications related to gastrointestinal tract were12.77%（6/47）in the TLG group,11.63%（5/43）in the LAG group and 14.28%（9/63）in the OG group,and 21.27%（10/47）in the TLG group,9.30%（4/43）in the LAG group and 9.52%（6/63）in the OG group.There were no significant differences（P > 0.05）.In terms of incisions related complications,0%（0/47）in the TLG group,4.65%（2/43）in the LAG group,and 11.11%（7/63）in the OG group were statistically significant（P <0.05）,but there was no significant difference between the TLG group and the LAG group in pairwise comparison of the three groups（P > 0.05）.There were significant differences between TLG group and OG group,LAG group and OG group（P < 0.05）.In terms of postoperative survival,there was no statistical significance in the rate of metastasis or recurrence in TLG group（17.02%,8/47）,LAG group（16.28%,7/43）and OG group（17.46%,11/63）（P > 0.05）.The mortality of TLG group was 6.38%（3/47）,LAG group 9.30%（4/43）,OG group 7.94%（5/63）,and the difference was not statistically significant（P > 0.05）.Conclusion: For cardiac surgical treatment of gastric adenocarcinoma,complete laparoscopic gastrectomy compared with laparoscopic gastrectomy auxiliary gastrectomy and laparotomy with less intraoperative blood loss,operative incision smaller,stomach tube into the advantage of shorter time,for the first time in operation time,postoperative exhaust,out of my bed for the first time,postoperative drainage tube and postoperative hospitalization days of the total,There was no significant difference between total laparoscopic gastrectomy and laparoscopic-assisted gastrectomy,but both of them were better than open surgery.There was no significant difference in postoperative complications and short-term survival rate among the three groups.Therefore,complete laparoscopic treatment of gastric adenocarcinoma of the cardia is safe and feasible in experienced teams,and the advantage becomes more obvious with increasing proficiency.Complete laparoscopic gastrectomy is worthy of further promotion,but the economic burden of patients should also be taken into account while considering the efficacy and medical experience of patients,and appropriate surgical methods should be selected according to the economic capacity of patients.