Relevancy Analysis Of CT Type ? And Surgical Approach For Adenocarcinoma Of The Esophagogastric Junction

BackgroundThe earliest adenocarcinoma of the esophagogastric junction was proposed by the German scholar Siewet.It refers to a tumor whose tumor center is within 5 cm of the fontanelle.Surgical treatment is the main treatment method for AEG.Due to the special growth area of the tumor,the common surgical approach is divided into three categories: transabdominal approach,transthoracic approach,and thoracoabdominal approach.However,there is no clear standard judgment at home and abroad.How to choose a surgical incision.Currently recognized Siewet classification divides AEG into three types,type I: the tumor center is located 1~5cm above the esophagogastric junction.Type II: The tumor center is located at lcm from the esophagogastric junction to 2cm below the line.Type III: The tumor center is located 2~5cm below the esophagogastric junction.This classification based on the area where the tumor is located is not conducive to determining the choice of surgical approach.Our hospital mainly adopts the CT three-quarter quartile method proposed by Henan Tumor Hospital to classify AEG patients.(1)Type I: The upper edge of the tumor is located below the plane of the lower edge of the cardia and can be completed completely through the abdomen.(2)Type II: The upper edge of the tumor is located between the plane at the top of the fundus and the plane of the lower edge of the cardia.The operation can be done via the abdominal approach.(3)Type III: The upper edge of the tumor is located between the plane of the top of the liver and the top plane of the fundus,and the operation is performed by a combined thoracoabdominal approach.(4)Type IV: The upper edge of the tumor is located above the plane of the top of the liver but does not involve the plane of the aortic arch.Thoracic and abdominal combined approaches should be performed to complete the operation.The related literature suggests that this type of method can accurately determine the choice of surgical approach before surgery,but type II still encounters a need for a combined thoracoabdominal approach in the course of clinical practice.This article aims to explore type II CT The clinical effect and related influencing factors of different surgical approach for adenocarcinoma of esophagogastric junction.MethodsA retrospective analysis of 118 cases of AEG patients with type II CT was performed during the period between January 2015 and January 2017 in the Second Affiliated Hospital of Zhengzhou University and Henan Cancer Hospital.According to the different methods of surgical approach,it was divided into transabdominal approach group and thoracoabdominal joint group.Preoperative records may influence the factors of surgical approach selection: patient's gender,age,BMI index,abdominal size,tumor pathological classification,clinical stage,and univariate and logistic regression analysis of various factors.The operative time,intraoperative blood loss,and postoperative complications were recorded in both groups.Recorded and statistical data were compared and analyzed.Results(1)Analysis of single factor results showed that there was no statistically significant difference in gender,age,tumor pathological classification,clinical stage,and surgical approach(P>0.05);BMI index,size of ventral horn,and choice of surgical approach Statistically significant(P<0.05).(2)According to the Logistic regression model,the size of the ventral horn was an independent factor in the choice of surgical approach for AEG(P<0.05).(3)The operation time of the two groups was less than that of the thoracoabdominal group.The difference was statistically significant(P<0.05);there was no significant difference in the blood loss between the two groups(P>0.05).(4)Postoperative complications and pulmonary complications: The abdominal group was less than the thoracoabdominal group,the difference was statistically significant(P<0.05).Conclusion(1)The patient's size-related factors may affect the choice of surgical approach for type II AEG patients with CT classification.The size of the ventral horn is an independent factor that influences the choice of surgical approach for type II CT classification AEG.BMI index is important The selection factor.(2)Combined operation of the thoracoabdominal group had a longer operation time and the pulmonary complications were higher than that of the abdominal group.Patients with poor preoperative lung function were not recommended for combined thoracoabdominal surgery.