Comparative Analysis Of Perioperative Period And Immune Function Of Patients With Adenocarcinoma Of Esophagogastric Junction Treated By Total Laparoscopy And Traditional Surgery

Objective:Compared with traditional open radical total gastrectomy,totally laparoscopic radical total gastrectomy for locally advanced adenocarcinoma of esophagogastric junction(AEG)perioperative effects on the cellular immune function(ratio of Helper T cells,ratio of Cytotoxic T cells and ratio of CD4+/CD8+,ratio of NK cells and ratio of T regulatory cell,ratio of total T cells,ratio of total B cells).Moreover,the effects of the two surgical procedures on the levels of four non-specific tumor markers(CEA,CA199,CA125,CA242,CA724)were compared.To provide evidence-based medical basis for clinicians in selecting surgical methods.Methods:A total of 106 patients who underwent TLRTG surgery in Shanxi Cancer Hospital from January 2016 to April 2020 were selected,and 98 patients who underwent TORTG surgery during the same period were selected.The short-term efficacy,preoperative and postoperative cellular immune function were compared between the two groups,and the levels of various tumor markers including CEA,CA199,CA125,CA242 and CA724 were compared between the two groups before and after surgery.Results:(1)There were no significant differences between the two groups in terms of basic information,including age,BMI and sex ratio.The mean age of patients in the TLRTG group was 59.16 years old,and that in the TORG group was 61.99 years old.The mean BMI in the TLRTG group was 23.92kg/m2,and that in the TORG group was 23.87 kg/m2.There was no significant difference in tumor location,stage and type between the two groups before and after operation.(2)The duration of operation in the TLRTG group was longer than that in the TORG group(P<0.01).In terms of incision length,intraoperative blood loss and the first postoperative exhaust time,the TLRTG group was superior to the TORG group,and the differences were statistically significant.There were no significant differences in the time of first feeding,postoperative hospital stay and the number of dissected lymph nodes.There was no significant difference in the incidence of postoperative complications between the two groups.(3)There were no statistically significant differences in preoperative Helper T cells,Cytotoxic T cells and CD4+/CD8+ratio between the TLRTG group and the TORG group.The ratio of Helper T cells,CD4+/CD8+and NK cells in peripheral blood of patients in the TLRTG group was significantly higher than that in the TORG group,while the ratio of Cytotoxic T cells and Tregs in the TLRTG group was significantly lower than that in the TORG group,the difference was statistically significant.(4)There were no significant differences in the preoperative CEA and CA199 levels between the two groups,but the levels of CEA and CA199 in the TLRTG group were lower than those in the TORG group 1 month after surgery(P<0.05).The levels of CA242 and CA724 in the TLRTG group and TORG group 1 month after surgery were lower than those before surgery(P<0.05),but there was no statistical difference in the levels of CA242 and CA724 between the two groups before and after surgery.Conclusion:(1)TLRTG surgery has the same radical effect and safety as TORG surgery,and can significantly reduce the incision length and intraoperative blood loss,and has little influence on postoperative gastrointestinal function of patients.(2)Compared with TORTG surgery,TLRTG surgery causes less trauma and stress response in patients,has less impact on the cellular immune function of patients,and can significantly reduce the levels of postoperative tumor markers CEA and CA199.