Clinical Research Of Difierent Surgical Approaches For Adenocarcinoma Of Esophagogastric Junction

Backgrounds:Recent years, the incidence rate of the adenocarcinoma of esophagogastric junction (AEG)has been rising around the world. Because of its special location, the surgical approachs can be differentiated into three ways, such as transabdominal, transthoracic and transthoracoabdominal. Thoracic surgery and general surgery both work on it. Different surgical approachs have their advantages and disadvantages, but not yet confirmed which surgical approach is more effective to improve patients’ survival rate.Objective:To compare the efficacy of the transthoracic and transabdominal surgical approachs in order to findout which one is more beneficial.Methods:Retrospectivel analysis the129and187patients of AEG type Ⅱ and Ⅲ who were separately treated by general surgery and thoracic surgery (from June,2007to February,2009). All the cases satisfied the inclusion criteria. The are grouped as transabdominal group and transthoracic group. Count the incidence of two groups patients with surgical approach, operative time, blood loss, surgical specimens of the cutting edge, cleaning number of the lymph node (including the number of lesser curvature’s lymph nodes, paraesophageal lymph node number), positive lymph nodes, and short-term complication after surgery. At last a statistic comparison was made between the two groups.Results:Pathological examination showed both the upper and lower cutting edge of the specimen of the two groups are clean. There are30cases which underwent total gastrectomy (23.9%) in the transabdominal group. The total cleaning lymph nodes number of the perigastric and the lymph nodes number of the lesser curvature are more than that in transthoracic group, with significant difference(P<0.01). The pertesophagus lymph node number is significantly reduced (P<0.01). The lesser curvature lymph node positive rate is75.5%, periesophagus lymph node positive rate is11.1%. In the transthoracic, there are8patients underwent total gastrectomy (5.2%). The lesser curvature lymph node positive rate is67.1%, periesophagus lymph node positive rate is21.8%. Abdominal surgery group has shorter operative time and less blood loss compared with the transthoracic surgery group with significant difference. Cases underwent total gastrectomy of abdominal group is more than the transthoracic group. The cleaning lymph nodes of the lesser curvature in total gastrectomy is more than that in proximal gastrectomy group(P<0.05). Short-term complications is less than the proximal gastrectomy group, but the patient age, operative time, blood loss and the total number of harvested lymph nodes Showed no significant difference.Conclusion:For the AEG Ⅱ and Ⅲ patients, both the transabdominal group and transthoracic group can achieve RO resection. The AEG type Ⅱ and type Ⅲ lymph node mainly metastasis in the abdominal cavity. The lesser curvature lymph node ositive rate is higher than that of the periesophagus lymph node, transabdominal surgery can clean more lymph nodes than transthoracic surgery group, which is maybe more meaningful to the postoperative recovery and prognosis. Total gastrectomy does better in cleaning perigastric lymph node especially in the lesser curvature lymph nodes, which is also meaningful to the postoperative recovery and prognosis.