Comparison Of Clinical Efficacy Of Transthoracic And Transabdominal Approaches In Treatment Of Siewert ? Adenocarcinoma Of Esophagogastric Junction

Objective:To compare the clinical efficacy of transthoracic and transabdominal approaches in the treatment of Siewert ? adenocarcinoma of the esophagogastric junction.Methods:Clinical data of 136 patients were collected retrospectively who were proved Siewert ? AEG and were admitted to the First Affiliated Hospital of Soochow University from January 2012 to January 2016.Cases were divided into transthoracic group and transabdominal group according to different surgical approaches.83 cases were part of transthoracic group while 53 were transabdominal group.Comparing the general information,operation time,intraoperative bleeding volume,proximal resection margin distance,positive surgical margins,the number of lymph nodes,the number of positive lymph nodes,postoperative hospital stay,postoperative complication and 3-year survival rate of two groups.Results:There was no significant difference in the general data between two groups(P>0.05);the transthoracic group had longer proximal resection margin distance(1.96±0.99cm)than the transabdominal group(0.96±0.72cm)(P<0.05).While the operation time of transthoracic group and transabdominal group was 212.58+64.75min VS 165.93±47.90min(P<0.05);intraoperative bleeding volume was 209.52ml±104.52ml VS 138.96±64.01ml(P<0.05);postoperative hospital stay was 14.87±3.44days VS 12.85±5.56 days(P<0.05);in transabdominal group,the operation time was shorter,intraoperative bleeding was less,and postoperative hospital stay was shorter(P<0.05).The number of lymph nodes dissected during operation in transthoracic and transabdominal group was 15.81±6.84 VS 17.32±5.37(P>0.05),and the number of positive lymph nodes was 3.46±4.87 VS 3.45±4.36)(P>0.05).Subgroup data showed that the number of lymph node dissection in total gastric group and proximal gastric group was 19.44±5.91 VS 15.12±3.71.More lymph nodes were resected in total gastric group(P<0.01).Meanwhile,13 cases appeared pulmonary infection after operation in transthoracic group and 2 cases in transabdominal group(P<0.05).There was no significant difference in other postoperative complications between the two groups(P>0.05).The 1-year and 3-year survival rates in transthoracic and transabdominal group respectively were 61.4%,41.0%and 67.9%,34.0%,with no significant difference(P>0.05).Conclusion:Transthoracic approaches and transabdominal approaches are both safe and feasible for the treatment of Siewert ? AEG.The proximal resection margin distance was longer in the transthoracic approaches group than in transabdominal approaches group.The operation time,intraoperative bleeding,postoperative hospital stay and pulmonary infection after operation were less than those in transthoracic approaches group.There was no significant difference in the number of lymph nodes,the number of positive lymph nodes,other postoperative complications(anastomotic fistula,empyema,incision infection,abdominal infection)and 3-year survival rate between the two groups.Therefore,appropriate surgical approach should be chosen according to the patient's specific conditions.