Clinical Comparison Of Laparoscopic And Open Resection Of Adenocarcinoma Of Esophagogastric Junction

Objective:To explore and evaluate the feasibility and safety between laparoscopic assisted and open radical resection of adenocarcinoma of esophagogastric junction.Methods:We retrospectively analyzed 78 patients who had been histopathologically diagnosed with adenocarcinoma of esophagogastric junction and underwent surgery at the Second Hospital of Dalian Medical University between January 2010 and December 2014. Thirty-eight cases of adenocarcinoma of the esophagogastric junction who underwent laparoscopic-assisted radical operation were classified as laparoscopic group and 40 cases of adenocarcinoma of esophagogastric junction who underwent traditional open radical resection were classified as laparotomy group. Operation methods, operation time, bleeding volume, distance from proximal and distal incised margins to lesion, number of lymph node resection, serum levels of C-reactive protein (CRP) at 24 hours,72 hours,5 days,7 days after surgery, anal exit time, eating semi-liquid diet time, postoperative hospital stay, complications after operation and total cost of hospitalization were compared between two groups.Results:Blood loss and length of the incision of laparoscopic group was significantly lower than laparotomy group (P<0.05). Operation time of laparoscopic group is significantly shorter than that of laparotomy group (P<0.05). The distance from cancer focus to proximal and distal incision margins between the two groups was statistically significant (P<0.05). The number of resection lymph node in laparoscopic group was significant increased than in laparotomy group (P<0.05). Serum levels of C-reactive protein at 24 hours,72 hours, and 5 days after operation between laparoscopic group and laparotomy group were not statistically significant (P>0.05). The postoperative complications in laparoscopic group comprised of 1 case of postoperative hemorrhage,2 cases of anastomotic fistula leakage, and 2 cases of intestinal obstruction. In the open operation group, the postoperative complications consisted of 3 cases of postoperative hemorrhage,3 cases of anastomotic fistula leakage, and 4 cases of intestinal obstruction. The clinical complication of laparoscopic group was significantly lower than laparotomy group (P<0.05).Conclusions:1. Laparoscopic assisted radical operation of adenocarcinoma of esophagogastric junction displays the characteristic of minimal invasion than open group from the perspectives of length of the incision and operation time.2. For distance from cancer focus to incision margin, the efficiency of laparoscopic assisted radical operation and open radical operation of adenocarcinoma of esophagogastric junction shows no significant difference. Notably, the efficiency of laparotomy group is favorable than open group from the perspective of resection number of lymph node.3. Comparison of postoperative anal exit time, eating semi-liquid diet time, hospitalization time, serum levels of C-reactive protein at different time point between the two groups indicate that laparotomy group has merits of minimal invasion and rapid recovery.4. Comparison of operation bleeding volume and postoperative complications between the two groups imply that laparoscopic assisted radical resection of adenocarcinoma of esophagogastric junction is safe and feasible.