A Retrospective Study About The Effect Of Different Surgical Approaches On The Treatment Of Patients With Siewert Type ? Adenocarcinoma Of Esophagogastric Junction

Objectives:This study compared the clinical and follow-up data of patients with Siewert type II AEG treated by different surgical approaches,including the length of hospitalization,the number of lymph node dissected,the level of complications,and long-term survival outcomes,and some other related factors.Therefore,the effects of different approaches on the prognosis of patients with Siewert type ? AEG were explored,and other possible influencing factors were also analyzed in part to provide some evidence for clinical work.Methods:The retrospective research method was used,and the electronic medical record system of Shandong Provincial Hospital was used to query and collect the medical records of Siewert type ? AEG patients who underwent gastrointestinal surgery and thoracic surgery from January 2013 to December 2013.Based on clear inclusion and exclusion criteria,a total of 181 eligible cases were included in this study.Among them,there were 41 cases of transabdominal AEG resection and 135 cases of transthoracic AEG resection.There were 4 cases in the thoracoabdominal approach and 1 in laparoscopic surgery.After baseline adjustments,the postoperative survival rates of patients with Siewert type ?AEG who underwent surgery in the abdominal and transthoracic groups were compared.Univariate screening was then used to screen for factors that were significantly associated with prognosis and to exclude related factors.The differences between the two groups were then stratified and compared according to the selected risk factors.Results:(1)Kaplan-Meier survival curve shows that as survival time prolongs,the survival rates of different surgical groups are slightly different,and the abdominal approach is slightly more advantageous,but Log-Rank test shows that There were no statistically significant differences in 3-year survival rate,5-year survival rate,and overall mean survival time between the transthoracic surgery group and the transabdominal surgery group(P=0.445).(2)After screening for risk factors and stratifying all relevant factors to make survival curves,we found that survival time is significantly related with age,tumor length,T stage,N stage,pTNM stage,number of lymph node metastases,histological grade,signet ring cells(95%CI:38.51?44.22,P<0.05).(3)The results of the comparative analysis of the length of hospitalization and the number of lymph node dissections of patients in different surgical approaches showed:compared with transthoracic approach group,the transabdominal approach group's length of hospitalization was shorter,and the number of lymph node dissection was larger(F=7.892,P<0.05).Conclusions:(1)The transthoracic approach group is inferior to the transabdominal approach in terms of postoperative recovery and morbidity;the transabdominal approach group is superior in abdominal lymph node dissection,and the total lymph node dissection is significantly better than the transthoracic approach group.In terms of patient survival time,the transabdominal approach group had a slight advantage,but the difference between the two did not show statistical significance(P>0.05).(2)The transabdominal approach has obvious advantages in reducing the length of hospital stay of patients.To a certain extent,it can be shown that the transabdominal approach is superior to the transthoracic approach in reducing the cost of hospitalization and reducing the length of hospital stay.(3)Analysis of follow-up data of patients showed that age factors,ASA classification,tumor length,tumor differentiation,presence or absence of signet ring cells,T staging,N staging,and pTNM staging were all related to patient survival And statistically significant(P<0.05).