胸腹部胃切除术和远端 2/3 食管切除术，广泛淋巴结清扫，用于治疗胃食管交界处 II 型和 III 型腺癌。

Thoracoabdominal gastrectomy and distal 2/3 esophageal resection with wide lymph node dissection for type II and III adenocarcinoma at the gastro-esophageal junction.

机构信息

Lund University, Skane University Hospital, Department of Surgery, Lund, Sweden.

出版信息

Am J Surg. 2019 Aug;218(2):329-334. doi: 10.1016/j.amjsurg.2018.11.049. Epub 2018 Dec 18.

DOI:10.1016/j.amjsurg.2018.11.049

PMID:30635210

Abstract

BACKGROUND

For locally advanced Siewert type II and III tumors we have performed total gastrectomy including resection of the distal 2/3 of the esophagus, through separate abdominal and right chest incisions (THX-ABD). The procedure involves wide lymphadenectomy in the abdomen/chest and a Roux-en-Y jejunostomy to the level of the azygos vein or above. The aim of the study was to investigate short- and long-term results for this rarely used procedure.

METHODS

Retrospective study of 83 radio-chemotherapy naïve patients with adenocarcinoma at the gastro-esophageal junction (Siewert type II n = 65 and type III n = 18) operated upon 1986-2011.

RESULTS

2/83 (2.4%) patients died in hospital. 70/83 (84%) patients had R0-resections. 82/83 (99%) patients had free longitudinal resection margins. Overall 5-year survival was 22/83 (27%).

CONCLUSION

THX-ABD can be performed with high rates of R0 resections and with low in-hospital mortality. Long-term survival rate was not better compared with less extensive surgical procedures.

摘要

背景

对于局部晚期的 Siewert II 型和 III 型肿瘤，我们通过单独的腹部和右侧胸部切口（THX-ABD）进行全胃切除术，包括食管远端 2/3 的切除。该手术包括在腹部/胸部进行广泛的淋巴结清扫和 Roux-en-Y 空肠造口术，达到奇静脉水平或以上。本研究旨在探讨这一很少使用的手术的短期和长期结果。