Ma Fei, Wang Weifeng, Guo Dandan, Zhang Yonglei, Peng Liangqun, Ma Qi, Ji Sheqing, Chai Junhui, Hua Yawei, Chen Xiaobing, Wang Hui, Xu Shuning, Li Qian, Luo Suxia, Yamashita Hiroharu, Lim Kheng Tian, Li Tian, Zhang Bin
Department of General Surgery, The Affiliated Tumor Hospital of Zhengzhou University, Zhengzhou, China.
Department of Gastrointestinal Surgery, Xinchang Hospital Affiliated to Wenzhou Medical University, Shaoxing, China.
Ann Transl Med. 2021 Feb;9(4):352. doi: 10.21037/atm-21-130.
To investigate the safety and merits of laparoscopic proximal gastrectomy with double-tract reconstruction (LPG-DT) for Siewert type II and III adenocarcinoma of the esophagogastric junction (AEG).
Retrospective analysis of the clinical data of 100 consecutive patients with Siewert II and III AEG treated at the Affiliated Tumor Hospital of Zhengzhou University from October 2010 to October 2019 was performed. Out of these patients, 69 underwent open proximal gastrectomy with double-tract reconstruction (OPG-DT), while 31 underwent LPG-DT. The clinicopathological characteristics, perioperative data, and short-term outcomes of the two groups were compared. A P value <0.05 was considered statistically significant.
Males accounted for 87% of all patients. Lymph nodes (LNs) count, time to first meal, postoperative length of stay, and postoperative complications were similar between the OPG-DT and LPG-DT group. flatus time was significantly shorter in the LPG-DT group (P<0.05), while the duration of operation was significantly shorter in the the OPG-DT group (P<0.001). Furthermore, the LPG-DT group has less blood loss, shorter flatus time, and lower postoperative-day-5 white blood cell (WBC) count and C-reactive protein (CRP) levels (P<0.05).
Although LPG-DT took longer to perform, its advantages of reduced blood loss and less surgical stress reflected on inflammatory markers supports an acceptable surgical option for Siewert II and III AEG.
探讨腹腔镜近端胃切除术联合双通道重建（LPG-DT）治疗食管胃交界部（AEG）Siewert II型和III型腺癌的安全性及优点。
回顾性分析2010年10月至2019年10月在郑州大学附属肿瘤医院连续收治的100例Siewert II型和III型AEG患者的临床资料。其中，69例行开放近端胃切除术联合双通道重建（OPG-DT），31例行LPG-DT。比较两组的临床病理特征、围手术期数据及短期结局。P值<0.05被认为具有统计学意义。
所有患者中男性占87%。OPG-DT组和LPG-DT组之间的淋巴结（LNs）计数、首次进食时间、术后住院时间及术后并发症相似。LPG-DT组的排气时间明显更短（P<0.05），而OPG-DT组的手术时间明显更短（P<0.001）。此外，LPG-DT组的失血量更少、排气时间更短，术后第5天的白细胞（WBC）计数和C反应蛋白（CRP）水平更低（P<0.05）。
尽管LPG-DT的手术时间较长，但其减少失血量和减轻手术应激（反映在炎症标志物上）的优点表明，对于Siewert II型和III型AEG来说，它是一种可接受的手术选择。
