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• W3029386523 abstract "ObjectiveTo investigate the safety and feasibility of totally laparoscopic transabdominal-hiatal approach in the treatment of Siewert type Ⅱ adenocarcinoma of esophagogastric junction (AEG).MethodsThe retrospective and descriptive study was conducted. The clinicopathological data of 11 patients with Siewert type Ⅱ AEG who were admitted to Affiliated Hangzhou First People′s Hospital of Zhejiang University School of Medicine from May 2017 to July 2018 were collected. There were 8 males and 3 females, aged 56-72 years, with an average age of 63 years.Patients underwent radical resection of AEG by totally laparoscopic transabdominal-hiatal approach. Observation indicators: (1) surgical situations and postoperative recovery; (2) postoperative pathological examination; (3) follow-up and survival situations. Follow-up using outpatient examination and telephone interview was performed to detect postoperative adjuvant chemotherapy, complications, food intake, anastomosis patency, tumor recurrence and metastasis, and survival up to December 2018. Measurement data with normal distribution were presented as Mean±SD, measurement data with skewed distribution were presented as M (range), and count data were represented as absolute number or percentage.Results(1) Surgical situations and postoperative recovery: all the patients underwent totally laparoscopic radical resection of Siewert type Ⅱ AEG by transabdominal-hiatal approach, without conversion to open surgery or perioperative death. Of the 11 patients, 8 underwent total gastrectomy including 3 combined with splenic hilar lymph node dissection and 3 underwent proximal gastrectomy with double-tract reconstruction. Operation time, time of superior overlap esophagojejunostomy, volume of intraoperative blood loss, time for initial out-of-bed activities, time to first flatus, time to initial liquid diet intake, time of drainage tube removal were respectively (245±39)minutes, (60±12)minutes, (75±23)mL, (24±8)hours, (2.4±0.5)days, (3.5±0.8)days, (8.2±1.3)days respectively. There was no serious complication including postoperative hemorrhage, anatomotic fistula or death. Three patients had left pleural effusion, and were cured after thoracic drainage. The duration of postoperative hospital stay was (11.0±3.0) days. (2) Postoperative pathological examination: all the 11 patients had negative upper surgical margin. The length of proximal margin, tumor diameter, total number of lymph lodes harvested, and number of lower mediastinal lymph lodes harvested were (2.1±0.2)cm, (2.6±0.9)cm, (36.0±4.0)/case and (2.3±0.8)/case. Pathological examination showed adenocarcinoma in all the 11 patients. pTNM staging: 2 cases were in stage ⅠB, 4 cases in stage ⅡA, 3 cases in stage ⅡB and 2 cases in stage ⅢA. (3) Follow-up and survival situations: 11 patients were follow-up for 6-19 months, with a median time of 9 months. Chemotherapy regimeus were formulated according to the pathological examination. Nine patients received postoperative adjuvant chemotherapy, and 2 in stage ⅡB received no postoperative adjuvant chemotherapy. During the follow-up, 11 patients had no obvious reflux symptom or choking feeling, and the anastomosis was patent as evaluated by oral contrast agent and gastroscopy. There was no tumor recurrence and metastasis or death in the 11 patients.ConclusionTotally laparoscopic transabdominal-hiatal approach applied in the radical resection is safe and feasible for the treatment of Siewert type Ⅱ AEG, with good short-term outcomes.Key words: Adenocarcinoma of esophagogastric junction; Transabdominal-hiatal approach; Gastrectomy; Siewert type Ⅱ; Esophagojejunostomy; Laparoscopy" @default.
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• W3029386523 date "2019-06-20" @default.
• W3029386523 modified "2023-09-23" @default.
• W3029386523 title "Application value of totally laparoscopic transabdominal-hiatal approach in the radical resection of Siewert type II adenocarcinoma of esophagogastric junction" @default.
• W3029386523 doi "https://doi.org/10.3760/cma.j.issn.1673-9752.2019.06.014" @default.
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