经上腹左胸手术和Ivor-lewis手术治疗SiewertⅡ型食管胃交界部腺癌的疗效比较

Comparison of efficacy of upper abdominal left thoracic surgery and Ivor-lewis surgery for Siewert typeⅡadenocarcinoma of the esophagogastric junction

目的:对比经上腹左胸手术和Ivor-lewis手术治疗SiewertⅡ型食管胃交界部腺癌(adenocarcinoma of the esophagogastric junction,AEG)在术中和术后各参数中的差别,以及患者预后的差异。方法:回顾性收集320例于河北医科大学第四医院胸外科行根治性手术的SiewertⅡ型AEG患者的数据,其中行上腹左胸手术的患者175例,行Ivor-lewis手术的患者145例。比较两组患者的临床病理特征、术中和术后情况、总生存时间(overall survival,OS)和无病生存时间(disease-free survival,DFS),并对影响AEG患者预后的情况进行单因素和多因素分析。结果:两组患者在肿瘤最大直径、pTNM分期、pN分期和下残阳性方面比较有统计学差异(P<0.05);与Ivor-lewis手术相比,行上腹左胸手术患者的术中时间缩短了30 min(P=0.034),术后吻合口瘘发生率更低(1.71%vs 4.83%,P=0.041);相比Ivor-lewis患者,行上腹左胸手术的患者可以获得更好的OS和DFS(P<0.05);单因素和多因素分析显示术前新辅助治疗是SiewertⅡ型AEG患者预后的影响因素(P<0.05)。结论:经上腹左胸手术可以彻底切除肿瘤,保留膈肌的完整,缩短开胸时间,有利于术后快速康复。同时,术后吻合口瘘等并发症的发生率低,有利于及时进行术后辅助治疗,更利于改善AEG患者的预后。

Objective:To compare the difference between upper abdominal left thoracic surgery and Ivor-lewis surgery for Siewert type II adenocarcinoma of the esophagogastric junction(AEG)in various parameters during and after surgery,as well as the difference in prognosis of patients.Methods:320 patients with Siewert typeⅡAEG who underwent radical surgery in department of thoracic surgery of the Fourth Hospital of Hebei Medical University were retrospectively enrolled,including 175 patients with upper abdominal left thoracic surgery and 145 patients with Ivor-lewis surgery.The clinicopathological characteristics,intraoperative and postoperative conditions,overall survival(OS)and disease-free survival(DFS)of the two groups were compared,and the prognosis of AEG patients was analyzed by univariate and multivariate analysis.Results:There were statistical differences between the two groups in terms of maximum tumor diameter,pTNM stage,pN stage and inferior stump of tumor(P<0.05).Compared with Ivor-lewis,the operative time of upper abdominal left thoracic surgery was shortened by 30 min(P=0.034),and the incidence of anastomotic leakage of upper abdominal left thoracic surgery was lower(1.71%vs 4.83%,P=0.041).Compared with patients with Ivor-lewis,patients with upper abdominal left thoracic surgery can obtain better OS and DFS(P<0.05).Univariate and multivariate analysis showed that preoperative neoadjuvant therapy was the prognostic factors of SiewertⅡAEG patients(P<0.05).Conclusion:The upper abdominal left thoracic surgery can completely remove the tumor,preserve the integrity of diaphragm,shorten the thoracotomy time,and facilitate rapid postoperative recovery.In addition,the incidence of complications such as anastomotic leakage was low,which can facilitate timely adjuvant therapy after surgery and improve the prognosis of AEG petients.