Lee Yoontaek, Min Sa-Hong, Park Ki Bum, Park Young Suk, Ahn Sang-Hoon, Park Do Joong, Kim Hyung-Ho
Department of Surgery, Seoul National University Bundang Hospital, Seongnam, Korea.
J Gastric Cancer. 2019 Mar;19(1):62-71. doi: 10.5230/jgc.2019.19.e1. Epub 2019 Jan 31.
The laparoscopic transhiatal approach (LA) for adenocarcinoma of the esophagogastric junction (AEJ) is advantageous since it allows better visualization of the surgical field than the open approach (OA). We compared the surgical outcomes of the 2 approaches.
We analyzed 108 patients with AEJ who underwent transhiatal distal esophagectomy and gastrectomy with curative intent between 2003 and 2015. Surgical outcomes were reviewed using electronic medical records.
The LA and OA were performed in 37 and 71 patients, respectively. Compared to the OA, the LA was associated with significantly shorter duration of postoperative hospital stay (9 vs. 11 days, P=0.001), shorter proximal resection margins (3 vs. 7 mm, P=0.004), and extended operative times (240 vs. 191 min, P=0.001). No significant difference was observed between the LA and OA for intraoperative blood loss (100 vs. 100 mL, P=0.392) or surgical morbidity rate (grade≥II) for complications (8.1% vs. 23.9%, P=0.080). Two cases of anastomotic leakage occurred in the OA group. The number of harvested lymph nodes was not significantly different between the LA and OA groups (54 vs. 51, P=0.889). The 5-year overall and 3-year relapse-free survival rates were 81.8% and 50.7% (P=0.024) and 77.3% and 46.4% (P=0.009) for the LA and OA groups, respectively. Multivariable analyses revealed no independent factors associated with overall survival.
The LA is feasible and safe with short- and long-term oncologic outcomes similar to those of the OA.
对于食管胃交界腺癌（AEJ），腹腔镜经裂孔入路（LA）具有优势，因为与开放入路（OA）相比，它能更好地观察手术视野。我们比较了这两种入路的手术结果。
我们分析了2003年至2015年间108例行经裂孔远端食管切除术和胃切除术且有治愈意图的AEJ患者。使用电子病历回顾手术结果。
分别有37例和71例患者接受了LA和OA手术。与OA相比，LA术后住院时间显著缩短（9天对11天，P = 0.001），近端切缘更短（3毫米对7毫米，P = 0.004），手术时间延长（240分钟对191分钟，P = 0.001）。LA和OA在术中失血量（100毫升对100毫升，P = 0.392）或并发症手术发病率（≥II级）方面无显著差异（8.1%对23.9%，P = 0.080）。OA组发生2例吻合口漏。LA组和OA组收获的淋巴结数量无显著差异（54个对51个，P = 0.889）。LA组和OA组的5年总生存率和3年无复发生存率分别为81.8%和50.7%（P = 0.024）以及77.3%和46.4%（P = 0.009）。多变量分析显示无独立因素与总生存相关。
LA可行且安全，其短期和长期肿瘤学结果与OA相似。
