Application Of Different Surgical Methods In Radical Operation Of Proximal Gastric Cancer

Objective To investigate the clinical efficacy of double-channel reconstruction after proximal gastrectomy,esophageal remnant-gastric anastomosis and total gastrectomy Roux-en-Y reconstruction in patients with proximal gastric cancer,so as to compare the advantages and disadvantages of the three different anastomosis methods,It is expected to provide a reference for the selection of digestive tract reconstruction methods in clinical practice.Methods A retrospective study was conducted on 393 patients with proximal gastric cancer who were diagnosed and underwent surgical treatment in Medical University General Hospital from January 2015 to December 2020.According to different surgical methodsthey were divided into proximal gastrectomy with double tract reconstruction(PGDT)group(n=78),proximal gastrectomy with esophagogastrostomy(PG-EG)group(n=186),and total gastrectomy Resection Roux-en-Y reconstruction(total gastrectomy Roux-en-Y reconstruction,TG-RY)group 129 cases;compare and analyze the general data,intraoperative conditions,postoperative pathology and postoperative complications of the three surgical methods.The values of hemoglobin,albumin,and total protein at four time points before operation,1,3,and 6 months after operation were selected as nutritional indicators,and the long-term complications of patients in the three groups were followed up,and the nutritional risk screening table(NRS-2002)for nutritional score screening.Data analysis using SPSS27.0 software.One-way ANOVA was used to compare the measurement data conforming to the normal distribution and homogeneity of variance test.If not,the Kruskal-WallisH nonparametric test was used.Count data were compared using test or Fisher exact probability test.The Kaplan-Meier method was used to calculate the survival rate,and the survival curve was drawn using Graphpadprism9.0.software.The difference in survival rate among different groups was compared by Log-rank test.Cox proportional hazards regression model was used to analyze prognostic factors.P<0.05 was considered as a statistically significant difference.Results1.Comparison of general data of patientsThere was no significant difference in the general data among the three groups,including sex,age,preoperative BMI,smoking history,drinking history,past medical history and so on.In tumor stage(χ2=15.26 P=0.004),tumor differentiation(χ2=13.888 P=0.031),nerve invasion(60.3%、39.8%、47.3%,χ2=9.336 P=0.009),vascular cancer thrombus(51.3%、22.0%、47.3%,x2=30.713 P=0,total number of lymph node dissection(21.97±9.85、19.27± 10.08、23.81 ± 11.79,Z=13.692,P=0.001),bormann classification(x2=34.957 P=0),There were significant differences(P<0.05).2.Comparison of patients in perioperative periodThere was no significant difference in intraoperative bleeding,intraoperative blood transfusion,intraoperative erythrocyte transfusion,postoperative blood transfusion,postoperative plasma transfusion,postoperative hospital stay and combined organ resection among the three groups(P>0.05).The operation time was 234.36 140.57,203.41 ±45.56 and 227.87±39.76 respectively(P= 0).The operation time of PG-EG group was shorter than that of PG-DT and TG-RY.Surgical approach(χ2=18.644 P=0),postoperative conversion to ICU(15.4%、3.2%、13.2%,χ2=14.335 P=0.001),postoperative blood transfusion(10.3%、4.3%、12.4%,χ2=7.266 P=0.026),postoperative red blood cell transfusion(0.71 ±3.00、0.21 ± 1.26、0.21 ± 1.26,Z=8.819,P=0.012).Compare PG-EG with TG-RY(Z=-16.343,P=0.017).The difference was statistically significant(P<0.05).3.Comparison of recent complications in patientsThere was no significant difference in anastomotic fistula,anastomotic stricture,pulmonary infection,poor pulmonary dilatation,other pulmonary complications,cardiac complications,disturbance of gastric emptying and anastomotic inflammation(P>0.05).There were significant differences in intestinal obstruction(1.3%.8.1%、11.6%,χ2=7.176 P=0.028),hypoproteinemia(79.5%、78.5%、95.3%,x2=17.928 P=0)and death within 30 days(3.8%、0.5%、1.6%,x2=3.733 P=0.090).4.Comparison of long-term complications in patients(1)There were significant differences in abdominal distension(10.8%.5.8%、21.9%,x2=13.946 P=0),diarrhea(7.7%、4.3%、19.8%,x2=15.464 P=0)and Visick grade(x2=27.966 P=0).(2)Malnutrition(15.4%、19.6%、36.5%,x2=12.273 P=0.002)and postoperative BMI(χ2=16.430 P=0.012)were significantly different(P<0.05).(3)There were significant differences in hemoglobin between EG group and RY group at 1 month,3 months and 6 months after operation.There were significant differences in hemoglobin between EG group and RY group at 1 month,3 months and 6 months after operation.There was significant difference in hemoglobin between DT group and RY group at 6 months after operation(F=7.184,P=0.029).In terms of serum albumin,there were differences among the four time points(F=26.879,P<0.001).In terms of serum total protein,there was significant difference among the four time points(F=4.218,P=0.008),but therewas no significant difference in other aspects(P>0.05).5.Comparison of living conditionsCox univariate analysis showed that age,postoperative conversion to ICU and tumor stage were related to survival time.The results of cox multivariate analysis showed that tumor stage and age were the prognostic risk factors of proximal gastric cancer.The 1,3 and 5-year survival rates of the PG-DT group were 89.2%,70.1%and 47.9%,respectively.The 1,3 and 5-year survival rates of the PG-DT group were90.6%,66.8%and 51%,respectively.The 1,3-and 5 year survival rateswere 90.6%,70.2%and 55.1%,respectively.There was no significant difference in overall survival amongthe three groups(c2=1.244 P=0.537).There was significant difference in survival rate among different tumor stages(c2=1.244 P=0.537).There was no significant difference in the overall survival rate among the three surgical methods in stage Ⅰ(c2=0.172,P=0.918).There was no significant difference in the overall survival rate among the three surgical methods underⅠ Ⅱ staging(c2=0.05,P=0.975).There was significant difference in overall survival rate among different surgical procedures according to Ⅲ staging(c2=6.023,P=0.049).There was asignificant difference insurvival rate between the two age groups based on the age of 65(c2=27.238,P<0.005).Conclusion1.PG-DT operation is safe and reliable.Except for a slightly longer operation time,it doesnot increase perioperative risk,short-term and long-term complications.2.PG-DT has an advantage over PG-EG in anti-reflux.3.Compared with TG-RY,PG-DT has advantages in improving long-term hemoglobin level,postoperative nutritional status,short-term and long-term postoperative complications.4.In stage Ⅰ and Ⅱ,PG-DT can ensure the safety of tumor,so it is an ideal method of operation.The survival rate of TG-RY in Ⅲ stage is higher,and TG is the first choice.