进展期食管胃交界腺癌临床病理分析319例

Different surgical approaches for adenocarcinoma of the esophagogastric junction

AIM: To investigate the therapeutic effects of different surgical approaches for adenocarcinoma of the esophagogastric junction (AEG).

METHODS: One hundred and fifty AEG patients were randomly divided into either an experimental group or a control group. The experimental group underwent surgery via a transabdominal approach, while the control group was treated via a transthoracic approach. The operation situation, postoperative pathology and complications were compared between the two groups.

RESULTS: There were significant differences in mean operative time (187.42 min ± 48.47 min vs 225.79 min ± 83.98 min), mean blood loss (128.09 mL ± 48.95 mL vs 208.01 mL ± 70.12 mL), number of paraesophageal lymph nodes (0.18 ± 0.67 vs 0.18 ± 0.67), number of cleared lymph nodes (12.71 ± 7.19 vs 8.20 ± 5.31), number of lymph nodes in the lesser curvature (6.51 ± 3.09 vs 1.72 ± 1.83), number of paraesophageal lymph nodes (12 vs 44), and number of cleared lymph nodes in the lesser curvature (330 vs 102) between the experimental group and control group (All I < 0.05). No significant difference was noted in the rate of positive margins (14.66% vs 10.66%, P > 0.05) between the two groups. The rate of positive curvature lymph nodes in the lesser curvature was significantly higher than that in the periesophagus in both groups (75.76% vs 11.11%, 66.04% vs 22.73%). No anastomotic fistula occurred in either group, although the complication rate was lower in the experimental group than in the control group (2.67% vs 14.67%, P < 0.05).

CONCLUSION: Transabdominal surgery can clear more lymph nodes than transthoracic surgery. Total gastrectomy does better in the clearance of perigastric lymph nodes, especially those in the lesser curvature.