Clinical Study Of The Gastroesophageal Junction Adenocarcinoma

The incidence of esophagogastric junction adenocarcinoma(EGJA)has rapidly increased at an alarming rate.EGJA has been treated as a separate entity,but the treatment strategy remains controversial.Directly to the hot spot for our work,we want to solve the following question: 1.How can we select correct surgical approach? 2.What was the law of the lymph node metastasis and the suitable extent of lymph node dissection.3.The relationship of the postoperative morbidity and mortality with the therapeutic method,and how can we control and decrease the complication?4.Survival analysis for EGJA,what was the prognostic relevance factor ?We retrospectively reviewed a database of 376 case of EGJA,during a period of five years(June 2006–November 2011).Siewert type I?II lymph node metastasis rate accounted for 65.7%.And the rate of lymph node metastasis of type III was 73.3%.For the type I EGJA carina lymph node metastasis rate was 5.68%,the lower peri-esophageal and inferior mediastinal lymph node metastasis rate was 27.27%,the right cardiac lymph node metastasis rate was 45.45%,the left cardiac lymph node metastasis rate was 29.54%,lesser curvature of stomach lymph node metastasis rate was 43.18%,greater curvature of stomach lymph node metastasis rate was 28.41,left gastric artery and celiac lymph node metastasis rate was 22%.For the type II EGJA carinal lymph node metastasis rate was 3.54%,lower peri-esophagus and inferior mediastinal lymph node metastasis rate was16.16% and the right cardiac lymph node metastasis rate was 50%,the left cardiac lymph node metastasis rate was35.85%,lesser curvature of stomach lymph node metastasis rate was42.93%,the greater curvature of the stomach lymph node metastasis rate was 24.74%,left gastric artery and celiac lymph node metastasis rate was32.83 %;For the type III EGJA lower peri-esophagus and inferior mediastinal lymph node metastasis rate is 3% and the right cardiac lymph node metastasis rate was 45.45%,the left cardiac lymph node metastasis rate was 29.54%,lesser curvature of stomach lymph node metastasis rate was 43.18%,the greater curvature of the stomach lymph node metastasis rate was 28.41%,left gastric artery and celiac lymph node metastasis rate was 22%.Siewert type I and type II EGJA lymph node metastasis had the character of thoracic-abdominal two-way,mainly metastasis to the Proximal gastric and lower mediastinal lymph nodes,rarely metastasis to upper and middle mediastinal lymph node.Siewert type III EGJA mainly metastasis to the gastric lymph nodes.From the summary of the general clinical pathological characteristics and the pattern of lymph node metastasis of EGJA,we can conclude that two field lymph node dissection around inferior mediastinum and proximal stomach should be the most suitable method for type I and type II EGJA,howerer,type III EGJA was only need perigastric lymph node dissection.The type of Postoperative complication of EGJA had undergone enormous changes,The incidence of anastomotic leakage and mortality had been greatly decreased,and it had been well controlled.However,the incidence and mortality of heart and lung complications still remain high.The preoperative accompanied by heart and lung diseases,diabetes and other serious complications in the abdominal approach group was higher than the thoracic and thoracoabdominal approach group,otherwise,the postoperative complications of lung and heart rate was lower than through left thoracic and thoracoabdominal approach groups.It was indicated that abdominal approach was advantageous to decrease cardiopulmonary complication.We compared the difference of surgical approach and analyzed the reason of postoperation complication,from the date we can find how can we select suitable surgical approach.R0 resection and lymph node dissection was two main emphasis that should be considered before select surgical approach,in this process,postoperative complications and operative risk should be considered too.If the EGJA was local disease and need not extended resection,type I and II EGJA,cardiac and pulmonary function can tolerate thoracic surgery,Left thoracic approach should be used to meet the scope of the lesion resection and the need for lymph node dissection.For the patients,who were elderly or combined with heart and lung disease,expected postoperative cardiopulmonary complications rate was high,or type III EGJA,abdominal approach would more suitable.There are 281 EGJA patients from 2007.7to 2011.11.Through 5years follow-up and survival analysis,indicated that the surgical approach,T stage? N stage ?pathological stage and degree of resection were related to prognosis,surgical approach and N stage is independent prognostic factor of EGJA.