The Recent Efficacy Of Different Surgical Approaches For Treating Siewert Ⅱ Adenocarcinoma Of The Esophagogastric Junction

ObjectiveThe aim of this study was to compare the recent outcomes of different surgical approaches in the treatment of Siewert II esophagogastric junction adenocarcinoma,to investigate the advantages and disadvantages of transthoracic,combined transthoracic and transabdominal approaches in the treatment of Siewert II esophagogastric junction adenocarcinoma,and to provide an evidence-based basis for the clinical treatment of Siewert II esophagogastric junction adenocarcinoma.MethodsRetrospective analysis of clinical data of 86 patients with Siewert II adenocarcinoma of the esophagogastric junction admitted to our department from January 2017 to December 2019.The patients were divided into three groups based on the surgical approach: 32 cases in the left thoracotomy(LT)group,30 cases in the Ivor-Lewis(IL)group,and 24 cases in the midline laparotomy(ML)group.Clinical data,perioperative indicators,postoperative complications,and 1-year and 3-year survival rates were compared among the three groups.Kaplan-Meier survival analysis was performed to evaluate survival time,and Log-rank test and Cox proportional hazards regression model were used for multivariate analysis.ResultsThe All patients in the three groups completed the surgery successfully and there were no perioperative deaths.Comparison of the general data of the three groups: no statistically significant differences in gender,age,degree of differentiation,tumour size,T-stage,N-stage,p TNM and postoperative adjuvant chemotherapy(P > 0.05).Comparison of perioperative data: intraoperative bleeding: IL group(423.33±93.52ml),LT group(345.31±83.63ml)and ML group(339.58±88.43ml),with statistically significant differences between the three groups(P<0.05).Operative time: IL group(371.93±27.91min),LT group(326.56±22.67min),ML group(322.62±22.39min),the difference between the three groups was statistically significant(P<0.05).Length of hospital stay: IL group(20.66±5.01 days),LT group(17.72±3.88 days),ML group(16.96±3.22 days),the difference between the three groups was statistically significant(P<0.05).Total number of lymph nodes cleared: IL group(23.26±3.92),LT group(17.19±3.35),ML group(18.42±4.42),with statistically significant differences between the three groups(P<0.05).Total number of positive lymph nodes: IL group(4.10±2.25),LT group(3.41±2.29),ML group(3.71±2.22),the difference between the three groups was not statistically significant(P>0.05).There was no statistically significant difference between the three groups in the total number of positive upper and lower tumour margins(P>0.05).Comparison of postoperative complications: There were no statistically significant differences in arrhythmias,pulmonary infections,pulmonary atelectasis,pleural effusion,abdominal infection,anastomotic fistula and anastomotic stenosis among the three groups(P>0.05),and statistically significant differences in total and pulmonary complications among the LT,IL and ML groups(P<0.05).Survival analysis:This study compared the 1-year and 3-year postoperative survival rates of the LT,IL and ML groups.The results showed that the 1-year survival rate was 80.3% and the 3-year survival rate was 49.5% in the LT group;the 1-year survival rate was 82.6% and the3-year survival rate was 47.5% in the IL group;and the 1-year survival rate was 87.5%and the 3-year survival rate was 51.2% in the ML group.The difference in survival curves between the three groups was not statistically significant by log-rank test(p=0.808).After one-way Cox regression analysis,degree of differentiation,tumour size,T stage,N stage,p TNM stage,total number of lymph nodes cleared,total number of positive lymph nodes and postoperative adjuvant chemotherapy were associated with prognosis(P<0.05).When they were included in the multi-factor Cox regression analysis,T stage and N stage were statistically associated with patient prognosis(P<0.05),indicating that T stage and N stage were independent risk factors affecting the prognosis of patients with Siewert II AEG.ConclusionThe combined thoracoabdominal approach was significantly better than the transabdominal and transthoracic approaches in terms of total lymph node dissection.The transabdominal approach was significantly better than the combined thoracoabdominal approach in terms of pulmonary complications,total complications,intraoperative bleeding,operative time and hospital days.There was no significant difference in survival rates at 1 and 3 years after combined thoracoabdominal,transthoracic and transabdominal approaches.T-stage and N-stage were independent risk factors affecting the prognosis of patients with Siewert II AEG.