Efficacy Analysis Of The Surgical Route For Siewert Type Ⅱ Adenocarcinoma Of Esophagogastric Junction

Objective:Compare the curative effect of of the three operation path(the transthoracic approach,the transabdominal approach and the combined thoracoabdominal approach)to Siewert type II adenocarcinoma of esophagogastric junction.Methods:The case-control data of patients with Siewert type II adenocarcinoma of esophagogastric junction who accepted curative surgery(the transthoracic approach,the transabdominal approach and the combined thoracoabdominal approach)between January 2012 and December 2017 at the Department of Gastroenterological and thoracic surgery in Shanxi Provincial People’s hospital were collected,and the patients were divided into transthoracic,transabdominal,and thoracoabdominal groups according to the choice of surgical route.The three groups were compared in terms of patient surgery related indicators,postoperative recovery,postoperative related complications and postoperative survival to study their differences.Results:There were no significant differences between the transthoracic and transabdominal groups regarding the length of operation time,intraoperative blood loss,gastric tube retention time,and hospital stay,but both groups were superior to the combined thoracic and abdominal group with significant differences(P<0.05).In terms of lymph node dissection,the thoracoabdominal combined group had the highest number of dissections(29.36±11.75),the transabdominal group were the second(24.15±10.68),and the transthoracic group were the least(18.04±6.62),which was different and statistically significant between the three groups(P=0.01).The total incidence of postoperative complications was significantly lower in the transabdominal group(26.76%)than in the transthoracic group(46.67%)and the thoracoabdominal combined group(56.82%)(P=0.005).The overall survival rates of the three groups were as follows: 35.7% in the transabdominal group,32.0% in the transthoracic group,and 34.4% in the thoracoabdominal combined group,with no significant differences among the three groups(P>0.05).Conclusion:For patients with Siewert type II AEG,decision-making can be made based on the distance of esophageal invasion,and when the distance of esophageal invasion is less than 4 cm,the transabdominal approach is more efficient,safe,and can reduce postoperative complications,making it a better choice.However,the thoracoabdominal combined approach cannot be completely discarded,and when the distance of esophageal invasion is greater than 4 cm,The combined thoracoabdominal group did not increase the perioperative mortality of patients.It is safe and feasible to ensure the postoperative survival rate of patients on the premise of increasing the scope of lymph node dissection.