Ⅱ, Ⅲ Type Of Esophagealadenocarcinoma With Urgery Clinical Study On The Treatment Of Surgical Approach And Resection Margin Safety Distance

[Objective]: Gastroesophageal junction adenocarcinoma(adenocarcinoma of esophagogastric junction, AEG) in recent years, the incidence rate showed a significant increasing trend, especially in Europe and the United States and other western countries in the past 30 years the incidence is increased by nearly 6 times for our country, the high mortality rate in Gansu area is gastric cancer. Research at home and abroad that adenocarcinomas of the esophagogastric junction different approach surgery the margin positive rate and long-term survival rate had no difference, and abdominal surgery with less trauma, has small influence on the heart and lung function, suitable for the elderly, patients with poor cardiopulmonary function. The esophagogastric junction adenocarcinoma of the surgery on the cut end of the safety distance is not a research conclusion, according to no residual cancer retrospective studies suggest that 3-12 cm, most studies suggest that more than 5cm for a safe distance, and transabdominal resection of carcinoma of esophagus is very difficult to cut card The conclusion of margin to the tumor can reach 12 cm. and the past are according to the postoperative pathological margin have residual cancer group, according to gross pathology reports of esophageal resection margins, were retrospectively analyzed, so the error is large, the lack of objective accuracy. In order to reduce the complications and residual cancer after reasonable minimum the safety margins will be the focus of the study. Esophageal gastric junction adenocarcinoma by transthoracic and transabdominal radical resection of esophageal length security research purpose is through the comparison of different length of the cutting edge, so that a more convenient clinical operation and safe abdominal esophageal resection margin standard distance, and the standard may be less than at present, most of that distance 5cm security, which will enable more elderly patients with poor cardiopulmonary function, avoid the fear of residual and transthoracic surgery to reduce postoperative complications and reduce surgical patients Injury, and to play a certain role in the clinical operation.[Materials and methods]: From 2014 to 2015 in Gansu Provincial Tumor Hospital Department of thoracic surgery, the surgical treatment of gastroesophageal junction adenocarcinoma after submission of gastroesophageal junction adenocarcinoma after thoracic abdominal surgery after treatment, tissue samples from 40 patients, male 52 cases, female 28 cases. Age range is 36- 77 years old, the average age of 58.6 years. The histological type should were adenocarcinoma, signet ring cell carcinoma of the histological diagnosis of mucinous adenocarcinoma into low differentiated adenocarcinoma group. High differentiated adenocarcinoma in moderately differentiated adenocarcinoma group, low in adenocarcinoma in low differentiation group; according to the degree of differentiation. Can be divided into: 7 cases high differentiated adenocarcinoma; 24 cases of moderately differentiated adenocarcinoma patients; 47 cases of poorly differentiated adenocarcinoma patients; the postoperative pathology showed 56 patients with lymph node metastasis in patients with no lymph node metastasis in 22 cases, postoperative pathological staging according to the American Joint Committee on cancer(JACC the seventh edition of the stomach) TNM cancer staging criteria, including 4 cases of I patients, 25 cases of II patients, 46 cases of III patients, 2 cases of stage IV patients. Surgery underwent D2 radical operation, to achieve R0 resection as the ultimate goal of the transthoracic surgery to esophageal and stomach stay relaxed, try not to stretch, tension, patients try to keep at a safe distance from the cutting edge, which is in operation on the 5cm margin, transabdominal gastroesophageal junction adenocarcinoma surgery, anatomy and tumor volume due to the limitation of the length of esophageal resection surgery, unless the diaphragmatic hiatus, otherwise it is difficult to like the transthoracic surgery that can with more than 5cm even more than 10 cm. So as far as possible to free the esophagus, cut the vagus nerve, the esophagus and stomach remain relaxed state, as far as possible to ensure the safe distance from tumor margin, two groups of surgical operation, after operation, postoperative fixation were measured after tumor distance on the margin of the distance according to the retraction the proportion of the public Type, get a reliable cutting edge distance. Postoperative observation of esophageal gastric junction adenocarcinoma in the cut edge length, the cutting edge of the dyeing there is no difference. All the data using SPSS19.0 software analysis, P < 0.05 suggested that there is statistical significance.[Results]: A total of 78 patients underwent radical surgery or palliative surgical resection, the average age of the patients was 58.6 years(range: age 36 years old to 77 years old); the transabdominal group of patients with a total of 38 cases of patients, the patients in thoracic surgery were 40 cases, male patients: 50 cases; female patients: in 28 cases, intraoperative exposure is good, smooth operation, one cases of patients with abdominal surgery, during surgery found gastroesophageal junction on the positive margin, then an additional cut part of the lower esophagus, 26 anastomosis, anastomotic with 1 black silk strengthen anastomosis, the patients were scheduled the operation mode of the successful completion of the surgery, of which 2 cases were treated with D1 radical mastectomy, more than D2, D3 resection, stapler in surgical margin showed no residual cancer, namely margin(-), postoperative pulmonary infection in 1 cases, no other complications such as anastomotic leakage, bleeding and serious complications, including the abdominal gastroesophageal junction A case of adenocarcinoma in patients with gastroparesis after operation, postoperative to positive after 43 days of treatment, recovery of gastrointestinal function. Because no patients died. The anastomotic margin length is calculated, and the fixed reservation pruned after stapling part, the transthoracic esophageal and gastric cancer with average department in the margin length 5.77cm(margin range: 5.10- 6.80cm), transabdominal esophagogastric adenocarcinoma patients on average margin length: 4.33cm(margin of the range of 3.20- 5.30cm), the No. 26 stapler was used during surgery, the distance to send another on the margin of 0.56cm; t the test of paired display, paired t test showed that there was a statistically significant difference between the three, specimens / intraoperative shrinkage rate was 60.14%, fixed / intraoperative contraction rate is about 45.8%, fixed / isolated shrinkage rate of 71.1%. a total of 89.8% patients underwent radical resection of proximal gastric cancer resection, 10.2% patients underwent total gastric resection Operation.After abdominal surgical patients and via thoracic approach surgery group were only in the operation time, intraoperative hemorrhage are different, the rest on the other send cutting edge negative rate, intraoperative clear lymph node sweeping the number of, postoperative complications and the average hospitalization time had no significant difference. For type II and type III esophageal stomach with adenocarcinoma patients, underwent transabdominal surgery group and the thoracic approach two different surgical approach, in on the margin of a positive rate and postoperative appeared complications and the average hospitalization time had no significant difference.[Conclusion]: For II type, III type of esophageal and gastric ministry for patients with prostate cancer, can be used by transthoracic surgical approach, can also use the transabdominal surgical approach, two patients could achieve the expected goal of the patients and its influencing factors including cardiac function, pulmonary function, regardless of shape. Is the transthoracic surgery, or abdominal surgery group should be as far as possible to ensure the tumor from the margin reached 5cm, the tumor margin should ensure that the measurement of tumor 4.33 cm in isolated specimens, all the resection margins were negative, no residual cancer. For patients with adenocarcinoma of the esophagogastric junction, abdominal can also to achieve radical resection effect, especially for the elderly and poor cardiopulmonary function, difficult to tolerate thoracotomy in patients with surgical treatment provides clinical reference.