A Comparative Study Of Hand-assisted Laparoscopy And Traditional Laparotomy In The Treatment Of Elderly Patients With Siewert Type Ⅱ And Ⅲ Esophagogastric Junction Cancer

【Background and purpose】 In recent years,the incidence of senile adenocarcinoma of the esophagogastric junction(AEG)in China has been continued to increase,but always be diagnosed in the middle and late stages,and surgical options are controversial.This article retrospectively analyzed the short-term effects of hand-assisted laparoscopy and traditional laparotomy in the treatment of elderly AEG in our hospital.To explore the short-term efficacy of hand-assisted laparoscopy in the treatment of AEG with minimal invasiveness,feasibility and safety.【Methods】 Retrospective analysis of some cases of Siewert Ⅱ and Siewert Ⅲ cases of radical adenocarcinoma of the esophagogastric junction at the hospital from January 2013 to June 2018.A total of 108 patients were included in this study,including traditional open AEG Radical surgery(control group)42 cases,hand-assisted laparoscopic AEG radical surgery(observation group)66 cases,the basic situation,surgical indicators,postoperative recovery,surgical inflammation indicators,postoperative complications and postoperative complications of the two groups of patients Follow-up studies and other comparative studies.【Results】 The control group consisted of 29 male and 13 female patients with an average age of 70.19 years old(range 60-80 years).The observation group contained 48 male and 18 female patients with an average age of 70.62 years old(range 62-79years).There was no significant difference between the two groups with regard to the age and gender,also the TNM stage,Siewert classification,tumor size,body mass index(BMI)and tumor cell differentiation.(P>0.05,Table 1).Patients in two groups were cured and discharged without perioperative death.In the control group,there were 2 cases of incision infection,3 cases of abdominal infection,2 cases of anastomotic leakage,9 cases of reflux esophagitis,and 3 cases of intestinal obstruction.The complications were relieved or cured after symptomatic treatment;In observation group,there were 12 patients with reflux esophagitis,all relieved or cured after symptomatic treatment.The overall difference of complications in the two groups was statistically significant(P <0.05,Table 5).The operation time,incision length,bleeding volume,anal exhaust,fluid intake,removal of abdominal drainage tube and postoperative hospital stay in the observation group were all less than those in the control group(P <0.05,Table 2 and table 3).There was no significant difference between lymph nodes counts and lymph nodes metastases(P> 0.05,Table 2).The level of WBC(leukocyte),CRP(C-reactive protein)on day 3,and PCT(procalcitonin)on day 3 after operation in HALS group were lower than those in traditional laparotomy group,the difference was statistically significant(P<0.05,Table 4).The tumor-free survival rate and mortality rate of the two groups of patients within 18 months after operation were not statistically significant(P>0.05,Table 6).【Conclusions】 1.Hand-assisted laparoscopic AEG radical surgery is equivalent to the short-term curative effect of traditional OS radical surgery.2.Hand-assisted laparoscopic AEG radical surgery has the advantages of short operation time,less intraoperative bleeding,and quick recovery after surgery,and fewer complications.Hand-assisted laparoscopic AEG radical surgery is safe and feasible,and is a practical minimally invasive technology.3.Hand-assisted laparoscopy(HALS)radical adenocarcinoma of esophagogastric junction is easy to operate,low in difficulty,low in team requirements,and low in laparoscopic equipment.It is worthy of widespread promotion in primary hospitals.