Zhang Yuan-Chuan, Wu Qing-Bin, Yang Xu-Yang, Yang Ting-Han, Wang Zi-Qiong, Wang Zi-Qiang, Zhou Zong-Guang
1 Department of Gastrointestinal Surgery, West China Hospital, Sichuan University , Chengdu, China .
2 West China School of Medicine, Sichuan University , Chengdu, China .
J Laparoendosc Adv Surg Tech A. 2018 Jul;28(7):845-852. doi: 10.1089/lap.2017.0692. Epub 2018 Mar 14.
To evaluate short-term and long-term outcomes of laparoscopic-assisted transhiatal esophagogastrectomy (LTEG) for treatment of adenocarcinoma of the esophagogastric junction (AEG).
Patients with AEG who underwent laparoscopic or open surgery at our department from October 2008 to December 2012 were enrolled in this retrospective study. Patients' demographics, perioperative outcomes, and survival data were collected.
A total of 136 patients with AEG were enrolled (103 patients underwent laparoscopic surgery and 33 patients underwent open surgery). Patient characteristics were comparable between two groups in terms of age, gender, tumor-node-metastasis stage, tumor size, preoperative complications, and type of surgery. The median operative time was longer in laparoscopic group (240 versus 210 minutes, P = .048). However, the estimated blood loss was less, and the rate of pleural rupture was lower in laparoscopic group (20 versus 70 mL, P < .001 and 18.4% versus 36.4%, P = .033, respectively). The rate of patients with pleural rupture requiring prolonged use of mechanical ventilation longer than 12 hours (6/31, 19.4%) was higher than that of patients without pleural rupture (6/105, 5.7%) (P = .019). The incidence of reflux symptoms at postoperative month six was similar in two groups (18.4% in laparoscopic group versus 24.2% in open group, P = .468), as well as the use of proton pump inhibitors (12.6% versus 15.2%, P = .709). Furthermore, the number of lymph nodes harvested (22 versus 25), 2-year cumulative overall survival rates (80.4% versus 57.5%), and the median survival times (51.52 months versus 24.24 months) were similar between two groups (P > .05).
LTEG is a safe, feasible, and oncologically effective procedure for AEG when performed by an experienced surgeon. Laparoscopic surgery is associated with a lower risk of pleural rupture, but pleural rupture in laparoscopic surgery may cause an adverse effect on the recovery of pulmonary function presumably due to tension pneumothorax.
评估腹腔镜辅助经裂孔食管胃切除术（LTEG）治疗食管胃交界腺癌（AEG）的短期和长期疗效。
本回顾性研究纳入了2008年10月至2012年12月在我科接受腹腔镜或开放手术的AEG患者。收集患者的人口统计学资料、围手术期结局和生存数据。
共纳入136例AEG患者（103例行腹腔镜手术，33例行开放手术）。两组患者在年龄、性别、肿瘤-淋巴结-转移分期、肿瘤大小、术前并发症和手术方式等方面的特征具有可比性。腹腔镜组的中位手术时间较长（240分钟对210分钟，P = 0.048）。然而，腹腔镜组的估计失血量较少，胸膜破裂率较低（20对70 mL，P < 0.001；18.4%对36.4%，P = 0.033）。需要机械通气超过12小时的胸膜破裂患者比例（6/31，19.4%）高于无胸膜破裂患者（6/105，5.7%）（P = 0.019）。术后6个月时两组反流症状的发生率相似（腹腔镜组为18.4%，开放组为24.2%，P = 0.468），质子泵抑制剂的使用情况也相似（12.6%对15.2%，P = 0.709）。此外，两组之间的淋巴结清扫数量（22对25）、2年累计总生存率（80.4%对57.5%）和中位生存时间（51.52个月对24.24个月）相似（P > 0.05）。
对于AEG，由经验丰富的外科医生进行LTEG是一种安全、可行且具有肿瘤学疗效的手术方法。腹腔镜手术与较低的胸膜破裂风险相关，但腹腔镜手术中的胸膜破裂可能会对肺功能的恢复产生不利影响，可能是由于张力性气胸所致。
