手术入路对食管胃结合部腺癌生存预后的影响

目的:评价经胸入路与经腹入路手术治疗SiewertⅡ/Ⅲ型食管胃结合部腺癌的临床疗效。方法:回顾分析2004年1月至2014年11月手术治疗的168例SiewertⅡ/Ⅲ型胃食管结合部腺癌患者的临床资料,对其人群特征、手术并发症、总生存率及生存预后的影响因素进行分析。结果:两组临床资料具有可比性,经胸入路组较经腹入路组手术时间短,但术后肺部并发症多,住院时间长。两组R0切除率、5年生存率(59.7%vs.64.5%)差异无统计学意义。多因素分析显示,T分期(P=0.008)、肿瘤分化程度(P<0.001)是食管胃结合部腺癌患者生存预后的影响因素。结论:在SiewertⅡ/Ⅲ型食管胃结合部腺癌中,经腹入路与经胸入路的生存预后相当。

The impact of surgical approach on survival and prognosis for patients with adenocarcinoma of esophagogastric junction

Objective:To evaluate the difference in overall survival between transthoracic and transhiatal-abdominal surgical approach for SiewertⅡ/Ⅲadenocarcinoma of esophagogastric junction.Methods:A retrospective analysis was performed on clinical data of 168 patients with SiewertⅡ/Ⅲadenocarcinoma of esophagogastric junction who received surgical treatment.The population characteristics,surgical complications,overall survival rate,and factors influencing survival prognosis were analyzed.Results:Groups were comparable at baseline and perioperative treatment.Transthoracic approach had shorter operation time than transhiatal-abdominal approach,but it had more postoperative pulmonary complications and longer hospital stay.There was no statistical difference in R0 rate and 5-year survival rate between the two groups(59.7%vs.64.5%).Multivariate analysis revealed T-stage(P=0.008)and tumor differentiation status(P<0.001)were independent factors of survival prognosis in patients with adenocarcinoma of esophagogastric junction.Conclusions:Survival prognosis is comparable between transthoracic and transhiatal-abdominal approaches for patients with SiewertⅡ/Ⅲadenocarcinoma of esophagogastric junction.