Abstract: Objective:To compare the clinical outcome of transthoracic and transabdominal hiatal approaches for the treatment of Siewert type Ⅱ and Ⅲ adenocarcinoma of the esophagogastric junction (AEG).
〖WTHZ〗Methods The clinical data of 334 patients with Siewert type Ⅱ and Ⅲ AEG who were admitted to the Affiliated Hospital of Qingdao University from July 2007 to July 2012 were retrospectively analyzed. There were 140 patients received transthoracic total or proximal gastrectomy+No.2 lymph node dissection (transthoracic group), and 194 patients received transabdominal hiatal total or proximal gastrectomy+No.2 lymph node dissection (transabdominal hiatal group). The intraoperative and short term conditions of the patients in the 2 groups were analyzed. Patients were followed up via phone call or out patient examination till July 2013. All data were analyzed using the t test, chi square test, Fisher exact probability or Kruskal Wallis test. The survival curve was drawn by Kaplan Meier method, and the survival rate was analyzed using the Log rank test.
Results:The operation time, lengths of esophagus resected, number of lymph node dissected, postoperative pain scores, duration of postoperative hospital stay, time of antibiotics usage, incidences of postoperative complications and total costs were (202±34)minutes,(4.1±1.1)cm, 17±7, 5.9±1.8, (13±6)days, (6.8±2.4)days, 27.14%(38/140) and (4.7±1.8) ×104 yuan in the transabdominal hiatal group, with signi ficant differences between the 2 groups (t=3.126, 2.634, 5.417, 4.662, 2.030, 9.384, χ²=4.127, P<0.05).
Conclusion:There was no significant difference in the 5 year survival rates between transthoracic and transabdominal hiatal approaches for the treatment of patients with Siewert type Ⅱ and Ⅲ AEG. The short term outcome of transabdominal hiatal approach is superior to that of transthoracic approach.