Effect of different surgical approaches on postoperative quality of life and survival of patients with Ⅱ, Ⅲ type adenocarcinoma of the esophagogastric junction / 肿瘤研究与临床

ABSTRACT

Objective To analyze the postoperative quality of life index and survival of Ⅱ,Ⅲ type adenocarcinoma of the esophagogastric junction (AEG) patients who were implemented radical surgery through the transthoracic approach or abdominal transhiatal approach.To explore the reasonable operative approach of Ⅱ,Ⅲ type AEG.Methods 139 cases of patients with Ⅱ,Ⅲ type AEG were prospectively enrolled into the group in Shanxi Cancer Hospital during March 2012 to September 2012.64 cases of them were in transthoracic approach (TT) group,and 75 cases in abdominal transhiatal approach (TH) group.The operative time,the residual incision margin cancer rate,the average number of lymph node dissection,postoperative hospital stay,the average number of days required for gastrointestinal function recovery,the incidence of cardiopulmonary complications,anastomotic leakage rate,postoperative bleeding rate,perioperative mortality,postoperative respiratory function decline rate within 1 year,the average weight loss after 1 year,postoperative reflux rate within 1 year,recurrence and metastasis rate within 1 year,and 1-year survival rate of two groups were respectively compared.Results Statistical analysis was done on the perioperative data of 139 patients,and regular follow-up was carried out for these 139 patients after they discharged from hospital,of which 26 cases were lost,the lost rate was 18.7 ％,so the followed-up cases were 113 cases.Postoperative hospital stay in transthoracic approach group was longer than abdominal transhiatal approach group with significant difference,(20.2±8.9) d vs (17.1±6.4) d (P ＜ 0.05),the average number of lymph node dissection in transthoracic approach group (15.2±7.5) was less than abdominal transhiatal approach group (23.0±13.0) with significant difference (P ＜ 0.05).No significant difference were observed in the operative time,the residual incision margin cancer rate,the average number of days required for gastrointestinal function recovery,the incidence of cardiopulmonary complications,anastomotic leakage rate,postoperative bleeding rate,perioperative mortality,postoperative respiratory function decline rate within 1 year,the average weight loss after 1 year,postoperative reflux rate within 1 year,recurrence and metastasis rate within 1 year,and 1-year survival rate of the two operation approaches (all P ＞ 0.05).Conclusions Abdominal approach,through the esophageal hiatus radical surgery is a preferred operative approach of Ⅱ,Ⅲ type AEG.The average number of lymph node dissection in abdominal transhiatal approach group was more than transthoracic approach group.It may have some influence on the prognosis.