| Background and aim: Endoscopic submucosal dissection(ESD)and endoscopic submucosal tunnel dissection(ESTD)are the main representatives of super minimally invasive surgery(SMIS),more and more Demonstrated safety and efficacy in the treatment of early adenocarcinoma of the esophagogastric junction(AEGJ).However,there is still a lack of research on the clinical efficacy evaluation and postoperative health-related quality of life(HRQo L)of digestive endoscopic SMIS versus surgical proximal gastrectomy(PG)in the treatment of early AEGJ in an accurately matched cohort,and the effect of the two surgical methods on gastric emptying function.Comparative studies are also blank.Therefore,this paper aims to conduct in-depth research on the above issues,in order to further clarify the superiority of super minimally invasive surgery in the treatment of patients with early AEGJ,so as to provide reliable evidence for the large-scale clinical application of this technology in the treatment of early AEGJ.Methods: This research mainly includes three parts.The first part is a comparative study on the clinical efficacy of SMIS and PG in the treatment of early AEGJ.We retrospectively analyzed the cases of early AEGJ treated with SMIS or PG in the First Medical Center of PLA General Hospital from January 2010 to December 2019 and the postoperative follow-up time was more than 1 year,and they were divided into SMIS group according to different treatment methods.and PG group,the follow-up observation indicators were postoperative complications,R0 resection rate,recurrence rate and survival period of the two surgical modes.The second part is a comparative study on the assessment of health-related quality of life after SMIS and PG for early AEGJ.The esophagogastric junction-specific evaluation scale(EORTC QLQ-OG25),gastroesophageal reflux disease questionnaire(GERD-Q)and Pittsburgh Sleep Quality Index(PSQI)were selected to form the core quality of life questionnaire.The HRQo L of the patients was investigated in the form of a questionnaire,and the factors affecting the postoperative HRQo L were explored.The third part is a prospective comparative study on gastric emptying function in patients with early esophagogastric junction cancer treated with SMIS and PG.We prospectively and consecutively selected patients with early AEGJ diagnosed at the First Medical Center of PLA General Hospital and Beijing Shijitan Hospital from January 2016 to December 2020,treated with SMIS and PG,and followed up for more than 5 years.Condition,gastroscopy,abdominal ultrasonography,gastroparesis cardinal symptom index(GCSI),and gastric emptying rate detection were the main follow-up monitoring indicators.Results: The results of the first part of the study are as follows: A total of 118 patients were included in this study.After 1:1 propensity score matching,the SMIS group and the PG group had no statistical significance in terms of lesion diameter,endoscopic classification,tumor differentiation,depth of invasion,and resection margin.difference(p > 0.05).No significant differences were observed in overall survival(OS)between the two groups(p = 0.603).The results of the second part of the study were as follows: PG patients had more severe reflux,dysphagia,dietary restriction,and sleep disturbance than SMIS patients(p < 0.05).The overall quality of life of the patients in the SMIS group was better than that of the patients in the PG group(p < 0.001),indicating that the patients in the proximal gastrectomy group had more severe symptoms and poorer quality of life.The results of the third part of the study are as follows: There were no significant differences in age,gender,weight recovery rate,and tumor stage between the two groups(p >0.05).The GCSI score of the SMIS group was lower than that of the PG group,with a statistically significant difference(p = 0.005).The rates of gastroscopic diagnosis of reflux esophagitis,gastric mucosal congestion and edema,bile reflux and gastric retention in the PG group were significantly higher than those in the SMIS group(p = 0.032 for reflux esophagitis,p = 0.005 for gastric mucosal congestion and edema,p = 0.028 for bile reflux,p = 0.018 for gastric retention).No significant difference was found between the SMIS gruop and the patients group in the diagnosis of cholecystolithiasis by abdominal ultrasonography(p = 0.145).The 4-hour gastric emptying rate of patients in the PG group was lower than that in the SMIS group,and there was a statistical difference between the two groups(p = 0.012).Conclusion: Super minimally invasive surgery for early AEGJ has a satisfactory clinical effect and HRQo L because it retains or establishes a structure that conforms to or is closer to physiology,and does not affect gastric emptying function,which changes the traditional surgical treatment mode to a certain extent.In the context of the current bio-psycho-social medical paradigm,organ-sparing ultra-minimally invasive surgery as the preferred treatment method will be a new paradigm for the treatment of early-stage AEGJ. |
