AB29. The study of the therapeutic effects of two surgical approaches for Siewert type II, III adenocarcinoma of esophagogastric junction

Objective: This paper discusses the differences between transthoracic approach and transabdominal approach of the patients with Siewert TypeII and III AEG, and aims to choose an ideal surgical approach for patients with Siewert TypeII and III AEG.

Methods: Chose and retrospectively analyzed the clinical data of 466 AEG II, III patients (382 male cases and 84 female cases) who had undergone surgery during 2004 to 2007 in the Fourth Affiliated Hospital of Hebei Medical University. Statistical analysis was conducted on figures from the two surgical approach groups, including operation time, blood loss, average time of hospital stay, positive rate of the upper and lower cut edge of the stump, average number of lymph node dissection, number of lymph node dissection in each group, metastasis rate of lymph node in each group, incidence of postoperative complications, patients’ 1-year, 3-year and 5-year survival rates after the surgery. SPSS19.0 software was applied to statistically describe and analyze the relevant data. Using chi-square test, t test, Kaplan-Meier method to draw survival curves, and log-rank test analysis of survival.

Results: The difference in operation time and blood loss was not statistically significant. The transthoracic approach group took a long time in surgery, and its average number of lymph node dissection was less. The transabdominal approach group had the lower positive rate of the lower cut edge of the stump. But the difference in the positive rate of the upper cut edge of the stump was not statistically significant. Compared with the transthoracic approach group, the transabdominal approach group had a higher lymph node metastasis rate in No.1-3 and No. 5-8. But in the rest groups the difference was not statistically significant. The comparison of overall the 1-year, 3-year, 5-year survival rates of the transthoracic approach and the transabdominal approach showed that the difference between the two groups was not statistically significant.

Conclusions: In order to reduce complications and improve the quality of life of patients, the transabdominal approach surgery is more reasonable for AEG II, III patients, especially for the older patients with poor physical basis. Transabdominal approach has an advantage in terms of therapeutic effects than transthoracic approach.

Keywords: Esophagogastric junction adenocarcinoma; Siewert TypeII and III AEG; transthoracic; transabdominal; lymph node metastasis rate; survival rate