| Objectives:To investigate the short and long-term effect of laparoscopic-assisted radial total gastrectomy(LATG)for Siewert typeⅡandⅢadenocarcinoma of the esophagogastric junction(AEG).Methods:A retrospective study in 119 cases of the Siewert typeⅡandⅢadenocarcinoma of the esophagogastric junction(AEG)patients were collected from January,2012 to December,2014 in our hospital,including 88 males and 31 females.Among them,there were 72 cases in LATG group and 47 in OTG group.The clinical data of two groups were analyzed and compared.(1)General data:age,sex,body mass index,anesthesia score,complications,Siewert classification,tumor size,histological differentiation,pathological staging,cancer embolus,T stage,N stage,TNM stage.(2)The situation in operation:the operation time,the amount of blood loss and blood transfusion in the operation,the thoracoabdominal resection rate,and spleen resection rate,frozen pathological examination(There were 62 cases in the LATG group and 21 cases in the OTG group).(3)Postoperative recovery index:the first time to go out of bed,the time of postoperative exhaust,the time of feeding flow,and the time of postoperative hospitalization.(4)Postoperative pathology and complications:the number of lymph node dissection,the number of lymph node positive cases,the distance of the proximal cutting edge,and the number of complications.(5)Follow up data:the time of recurrence,the time of death,and the time of postoperative survival.Follow up by out-patient,telephone,short message,or home visit,and the time of follow-up as of December 2017.Result:Two groups of patients in age,sex,body mass index,ASA grade,Comorbidity,Siewert classification,tumor size,histological differentiation,pathological staging,cancer embolus,T stage,N stage,TNM stage and other general data showed no significant difference(P>0.05).Two groups of patients with perioperative data,the short and long-term effects of statistical results are as follows:(1)Operation index:compared with the OTG group the index of intraoperative blood loss,blood transfusion rate,thoracotomy rate,splenectomy rate the LATG group more better(P<0.05),the LATG group and OTG group splenectomy rate(2.8%vs 25.5%,χ~2=14.183,P<0.001).The LATG group was longer than the OTG group in the operation time(230.78±55.14min vs 198.45±45.84min,t=5.529,P<0.001).(2)Postoperative pathological indexes:the number of lymph node dissection in the LATG group and OTG group were(35.69±12.57 vs 31.58±11.16,t=3.889,P=0.029),the length of proximal cut margin(3.09±0.71 cm vs 2.57±0.24 cm,t=4.973,P<0.001)were superior to those in the OTG group,and the difference was statistically significant.The number of positive lymph nodes and the positive cases of proximal marginal margin were no difference in the two groups(P>0.05).(3)The recent curative effect:no perioperative deaths in both two groups,two groups of patients in the postoperative ambulation time,postoperative complications had no significant difference(P>0.05),the postoperative exhaust time,postoperative eating liquid time,postoperative hospitalization time,extubation time on the LATG group were better than the OTG group(P<0.05).(4)The long-term curative effect:all patients in two groups for 3 years survival rate of LATG group due to OTG group(73.6%vs 55.3%,χ~2=4.264,P=0.039).The survival time of the LATG group better than the OTG group(60.27 months vs 49.62 months,χ~2=6.376,P=0.012).Further,stratification according to the Siewert classification,the 3 years survival rate LATG group due to OTG group(92%vs 61.9%,χ~2=6.076,P=0.014),the survival time in Siewert typeⅡof patients in LATG group was better than that in OTG group(68.11 months vs 52.48 months,χ~2=6.039,P=0.014).About Siewert type III,there was no significant difference in the survival time between LATG group and OTG group(55.53 months vs 46.81 months,χ~2=3.123,P=0.077).Cox proportional hazard regression model was used for multivariate analysis showed that surgical methods(RR=2.25,95%CI=1.03-4.91,P=0.031).Splenectomy(RR=1.97,95%CI=1.01-4.02,P=0.021),tumor diameter(RR=2.39,95%CI=1.03-5.54,P=0.009),the degree of tumor differentiation(RR=3.04,95%CI=1.20-7.73,P=0.000)and TNM staging(RR=2.33,95%CI=1.74-3.01,P=0.001)were the dangerous effects of patient survival factors.Conclusion:1、LATG for the treatment of the Siewert type II and III AEG,especially type II,not only has a more obvious minimally invasive advantage,but also has more benefit in the long-term survival.2、The improvement of long-term clinical efficacy of LATG may be related to the effective guarantee of sufficient resection range and more thorough lymph node dissection,and also may be related to its minimally invasive superiority,especially the lower splenic rate. |
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