Comparison Of Efficacy And Safety Of Different Surgical Approaches In The Treatment Of Siewert Type ? Adenocarcinoma Of The Esophagogastric Junction

Objective:To evaluate the efficacy and safety of different surgical approaches for treating Siewert type ? adenocarcinoma of esophagogastric junction.Methods:By searching PubMed,EMbase,CochraneLibrary,Web of science,and,WangFang and China National Knowledge Infrastructure databases,collecting published literatures about treating Siewert type ? adenocarcinoma of esophagogastric junction.Evaluation of literature quality and extracted data.A network meta-analysis was conducted using ADDIS16.6 and Stata14.0 software.Results:Twenty-eight studies were included,involving 4215 patients,with five different surgical approachs.No apparent inconsistencies about direct comparison and indirect comparison by the consistency test.Network Meta-analysis showed that there was no statistically significant difference on the 5 year survival rate with the five surgical approaches.The minimally invasive approach and the transabdominal approach were better than the other three surgical approaches such as the operation time,the amount of blood loss,the 30 day hospitalization mortality,cardiopulmonary complications,and the time of hospitalization,but were worse on the number of lymph node dissection,the incidence of anastomotic leakage and the positive rate of proximal marg.The left transthoracoabdominal surgical approachs and the Right transthoracoabdominal surgical approachs were better than other three surgical approchs such as the number of lymph node dissection,the incidence of anastomotic leakage and the positive rate of proximal margin,but were worse on the operation time,the amount of blood loss,the 30 day hospitalization mortality,cardiopulmonary complications,and the time of hospitalization.Conclusion:1.The five surgical approachs have no statistical difference in the long-term survival time of the patients,all of which can be used to treat Siewert type ? of adenocarcinoma of the esophagogastric junction.However,the minimally invasive approach can reduce the amount of blood loss,shorten the time of hospitalization,decline the rate of cardiopulmonary complications and the 30 day hospitalization mortality.It is suitable for the early AEG patients without no mediastinal lymph node.2.For Siewert type ? adenocarcinoma of esophagogastric junction with esophageal infiltration or mediastinal lymph node metastasis,thoracoabdominal approach was recommended.3.For patients with Siewert type ? adenocarcinoma of esophagogastric junction who was not able to tolerate severe trauma,they should be treated by transabdominal approach or minimally invasive approach.