Comparison Of Surgical Results Between Laparoscopic-assisted Radical Gastrectomy And Opened Radical Gastrectomy In Patients With Adenocarcinoma Of The Esophagogastric Junction

Objective To compare the clinical outcomes between laparoscopic-assisted radical gastrectomy(LARG)and opened radical gastrectomy(ORG)in AEG patients.Methods The clinical data including 136 patients with Siewert type ? or ? AEG who underwent radical gastrectomy were obtained retrospectively from January 2014 to January 2017 in our hospital.According to the propensity score matching method(PSM)involving age,sex,body mass index(BMI),tumor size,tumor stage and tumor grade,42 patients with LARG were matched to 42 ORG patients.Then,comparisons about the surgical results and prognosis were done between the matched groups.Results Compared with the ORG,LARG were significantly with less blood loss,blood transfusion rates and post-operative complication rates of Grade ? and ?(p<0.05).Moreover,the length of hospital stays was shorter in the LARG(p<0.05).However,the mean operation time was longer in LARG(p<0.05).Eventually,there were no significantly difference in total number of harvested lymph nodes,the length of proximal margin between groups and post-operative complication rates of Grade ?and IV(p>0.05).Time to first flatus and liquid-diet were similar between each other(p>0.05).The 2-year OS and DFS were 83.1%and 79.3%in the ORG group,severally,and 85.1%and 82.1%in the LARG group,severally(p>0.05).In univariate analysis,the overall survival percentage of 2-year was significantly associated with T stage,N stage,TNM stage and postoperative adjuvant chemotherapy(p<0.05).Meanwhile,the multivariate analysis was performed by the COX proportional hazard model and indicated that the TNM stage and postoperative adjuvant chemotherapy were major factors to survival prognosis for the matched group(p<0.05).Conclusions LARG might not significantly improve the prognosis of AEG patients comparing with ORG,however,the less blood loss,lower postoperative complication rates of Grade?-?,negative proximal margin and enough harvested lymph nodes dissection make it one of the feasible and safe surgical options.