Lymph node dissection for Siewert Ⅱ esophagogastric junction adenocarcinoma: a retrospective study of three surgical procedures / 中华胸心血管外科杂志

ABSTRACT

Objective The surgical approaches and extent of lymph node dissection for Siewert type Ⅱ adenocarcinoma of the esophagogastric junction(AEG) are controversial.The present study was aimed to investigate the application of right thansthoracic Ivor-Lewis(IL),left transthoracic(LTT),and left thoracoabdominal(LTA) approach in Siewert type Ⅱ AEG.Methods The data of 196 patients with Siewert type Ⅱ AEG received surgical resection in our cancer center between January 2014 and April 2016 was retrospectively analyzed.Finally,136 patients met the inclusion criteria were enrolled in the study and divided into the IL(47 cases),LTT(51 cases),and LTA group(38 cases).Clinical and short-term treatment effects were compared among the three groups.Results The patients with weight loss,diabetes,and heart disease increased in the LTT group (P =0.054,P =0.075,and P =0.063,respectively).Operation time was significantly longest in the IL group (P =0.000),but the amount of bleeding and tumor size did not significantly differ among the three groups (P =0.176 and P =0.228,respectively).The IL group had the significantly longest proximal surgical margin (P =0.000) and most number of total (P =0.000) and thoracic lymph nodes(P =0.000) dissected.Both the IL and LTA groups had more abdominal lymph nodes dissected than the LTT group(P =0.000).In general,the IL and LTT group had the highest dissection rates of every station of thoracic (P ＜ 0.05) and lower mediastinal lymph nodes (P ＜ 0.05),respectively.The dissection rate of the paracardial,left gastric artery,and gastric lesser curvature lymph nodes did not differ significantly among the three groups(P ＞ 0.05),but the dissection rate of the hepatic artery,splenic artery,and celiac trunk lymph nodes was significantly highest in the IL group (P ＜0.05).Postoperative hospital stay,perioperative complications,and mortality did not differ significantly among the three groups(P ＞ 0.05).Conclusion Compared with the traditional left transthoracic approach,the Ivor-Lewis approach did not increase the perioperative mortality and complication rates in Siewert type Ⅱ AEG,but obtained satisfactory length of the proximal surgical margin,and was better than left transthoracic approach in thoracic and abdominal lymph node dissection.However,the advantages of Ivor-Lewis procedure requires further follow-up and validation through prospective randomized controlled trials.