Total Gastrectomy And Proximal Gastrectomy In The Treatment Of Adenocarcinoma At The Junction Of Esophagus And Stomach Clinical Comparative Analysis Of Siewert ?

BackgroundGastric cancer is a common gastrointestinal malignancy,and its mortality rate ranks the second among the most common malignancies.Over the past 30 years,the incidence of gastric cancer has been decreasing year by year around the world,but the incidence of Adenocarcinoma of the esophagogastric(AEG)has been increasing.Due to the unique location of its onset,the symptoms are not obvious,most of them are in the middle and late stage when diagnosed in the hospital,which seriously endangers life and health.AEG Siewert classification is divided into: Siewert ? type,Siewert ? type,Siewert ? type is currently recognized classification method.At present,surgical treatment is still the most effective method to treat AEG.Type of Siewert ? type and Siewert ? AEG patients treatment and means has gained international recognition of medical experts.For Siewert ? type surgical treatment is still has not reached a consensus,and most experts now tend to abdominal surgery into the road,but the line of the proximal gastrectomy or total gastrectomy still exist in the debate.ObjectiveCompared to the total gastrectomy of abdominal and proximal gastrectomy two surgical treatment Siewert ? recently obtained by the integration of a type of esophageal gastric adenocarcinoma and the long-term clinical effect,for clinical work,select the abdominal approach surgery Siewert ? relevant basis was provided for the choice of operation in the AEG.Materials and methodsRetrospective analysis in January 2010 to December 2014 in Jiangsu Subei people's hospital of abdominal gastrointestinal center into the way of surgical treatment of Siewert ? type of clinical data of 160 patients with AEG,collected the patient's age range of 35 to 80 years old,male patients with a Total of 120 patients(75%),female,a Total of 40 cases(25%),according to the operation method is divided into Total gastrectomy group(Total gastrectomy,TG): a Total of 102 cases,including 75 cases of male patients,27 patients with women,men and women than 2.78:1),Proximal gastrectomy group(PG): a total of 58 patients,including 45 male patients and 13 female patients(male-female ratio 3.46:1).Perioperative general clinical data of two groups of patients(including: gender,age,body mass index(BMI),American Society of Anesthesiologists(ASA)classification,whether accompanied by chronic diseases,etc.)Length of surgical incision,operation time,blood loss during operation,fluid intaketime after operation,indwelling time of abdominal drainage tube,postoperative hospital stay,total hospitalization cost,postoperative complications,and pathological data The number of metastatic lymph nodes,tumor staging)and follow-up data(mainly including:postoperative survival time,recurrence rate and mortality rate)were compared and analyzed.ResultsStatistical analysis of preoperative clinical data(including: gender,age,BMI,ASA classification,and whether or not associated with chronic diseases)was performed between the two groups of patients.There was no significant difference between the two groups(P> 0.05).Statistical analysis of the average blood loss during surgery between the two groups of patients showed no significant difference between the two groups(P> 0.05).The statistical data of the average incision length,the average operation time,the total number of dissected lymph nodes,and the average number of dissected positive lymph nodes in the two groups were statistically analyzed.The PG group had shorter average incision length and shorter average operation time than the TG group.And the average total number of dissected lymph nodes and the average number of dissected positive lymph nodes were small.The difference between the two groups was statistically significant(P <0.05).The statistical analysis of the data on the time of fluid intake,postoperative hospital stay,and indwelling time of the abdominal drainage tube in the two groups of patients were not statistically significant(P> 0.05).The data of gastrointestinal decompression tube drainage was statistically analyzed.The average gastrointestinal decompression tube drainage on the first day(30.12 ±45.18ml)and the third day(81.98 ± 34.92ml)in the PG group was higher than that in the TG group.There were many days(9.68 ± 17.69ml)and the third day(39.82 ±59.39ml).The results showed that the difference between the two groups was statistically significant(P <0.05).The total cost of hospitalization of the two groups of patients was statistically analyzed.The average hospitalization cost of the TG group(5.83 ± 0.12 million yuan)was higher than that of the PG group(5.13 ± 0.14 million yuan).The difference between the two groups was statistically significant(P <0.05).Postoperative tumor staging analysis was performed between the two groups of patients,and the difference between the two groups was not statistically significant(P>0.05).Statistical analysis of the 1-year and 3-year postoperative survival and recurrence rates in the two groups showed no significant difference between the two groups(P>0.05).The 5-year survival rate of the two groups was statistically analyzed.The TG group(33.33%)was higher than the PG group(27.59%),and the recurrence rate of the TG group(48.04%)was lower than that of the PG group(60.34%).The difference between the two groups was statistically significant.Significance(P <0.05).There was no statistically significant difference in the 5-year survival rate betweenthe two surgical methods for the treatment of Siewert type II AEG patients at stage I and II(P> 0.05).Total gastrectomy for patients with Siewert type ? AEG in stage ? benefited more in 5-year survival rate,and the difference between the two groups was statistically significant(P <0.05).Conclusion1 ? Proximal gastrectomy via abdominal approach has advantages over total gastrectomy in terms of incision length,operation time,and hospitalization costs,but its5-year survival rate is low and its tumor recurrence rate is high.2 ? Siewert ? integration of a type of esophageal gastric adenocarcinoma abdominal surgery into the road,though full stomach resection and proximal gastrectomy no differences in the incidence of postoperative complications,but the line total gastrectomy is more advantageous to thoroughly clean the lymph nodes,and the long-term survival and relapse rate,total gastrectomy has more advantages,to achieve better long-term outcomes.Total gastrectomy via abdominal approach is recommended.3?Compared with patients with stage I and II of Siewert type II AEG,it is more appropriate to choose total gastrectomy for patients with stage III of Siewert type II AEG.