Comparative Study Of Different Surgical Methods In The Treatment Of Adenocarcinoma Of The Esophagogastric Junction

Objective:Adenocarcinoma of the esophagogastric junction is commonly referred to as cardiac cancer in China.There are a variety of surgical procedures for Adenocarcinoma of esophagogastric junction.The purpose of this study was to investigate the therapeutic effect of the two methods of the left chest approach and the transabdominal + right chest approach in the treatment of esophageal and gastric junctional adenocarcinoma.Methods:From January 1,2018 to January 1,2019,a retrospective analysis was performed in 63 patients undergoing esophagogastric junction adenocarcinoma resection in the Department of Thoracic Surgery,Fourth Hospital of Hebei Medical University.There were 42 patients in the left chest approach group and 21 patients in the upper abdomen + right chest approach.The operation time,surgical bleeding volume,oral feeding time,gastric tube indwelling time,thoracic closed drainage tube indwelling time,24-hour postoperative drainage,number of lymph nodes,positive lymph nodes,number of lymph nodes removed,total hospital stay and recent complication rate were statistically analyzed.Statistical methods: The relevant data of this study was processed by SPSS24.0 software.Results: The operation time of the left chest approach group was lower than that of the upper abdomen + right chest group(P<0.001).The average of thoracic closed drainage tube in the left chest approach group has a short retention time(P=0.01<0.05).The 24-hour average drainage volume in the left chest approach group was smaller than that in the upper abdomen + right chest approach group(P<0.001).The average of total length of hospital stay in the left chest approach group is shorter(P=0.042<0.05).The average number of lymph node dissection in the left thoracic approach group was less than that in the upper abdomen + right thoracic approach group(P<0.001).The average number of lymph node dissection group in the left thoracic approach group was less than that in the upper abdomen + right thoracic approach group(P<0.001).There were no statistically significant differences between the two groups in the amount of blood loss,the time of postoperative feeding,postoperative gastric tube indwelling time,and the number of positive lymph nodes.In terms of the incidence of postoperative short-term complications: In the left thoracic approach group,the probability of postoperative pleural effusion(re-pleural puncture after extubation)was lower(P=0.001<0.05).There were no statistically significant differences between the two groups in hoarseness,poor expectoration,unplanned secondary surgery due to complications,anastomotic fistula,anastomotic bleeding,pneumonia,respiratory failure,ventilatory-assisted therapy,arrhythmia,incision infection,and incision fat liquefaction.No gastric stump perforation,tracheoesophageal fistula,chylothorax,atelectasis,incision dehiscence or complications related deaths occurred in either group.Conclusions:1 The upper abdomen + right thoracic approach group was significantly better than the left thoracic approach group in terms of lymph node dissection scope and number,and the degree of radical surgery was higher.2 The incidence of pleural effusion was higher in the upper abdomen + right thoracic approach group,there was no significant difference in the incidence of other complications between the two groups.3 The upper abdomen + right thoracic approach group had two incisions,the operation time was significantly longer than that of the left thoracic approach group.The surgery of the the upper abdomen + right thoracic approach group is more traumatic,and the recovery was more slower after surgery.