Comparative study on the prognostic effects between laparoscopic transabdominal approach and thoracoscopic laparoscopic combined approach in treatment of adenocarcinoma of esophagogastric junction
- VernacularTitle:腹腔镜经腹入路与胸腹腔镜联合入路治疗食管胃连接部腺癌预后效果的对照研究
- Author:
Yuhong WANG
1
;
Yifan LI
1
;
Jing LI
1
;
Wei ZHANG
1
Author Information
- Publication Type:Journal Article
- Keywords: laparoscope; lower mediastinal lymph node dissection; thoracoscopic laparoscopic combined approach; adenocarcinoma of esophagogastric junction (AEG); prognosis
- From: China Journal of Endoscopy 2024;30(12):9-20
- CountryChina
- Language:Chinese
- Abstract: Objective To compare the prognosis effects between laparoscopic transabdominal approach and thoracoscopic laparoscopic combined approach in treatment of adenocarcinoma of esophagogastric junction (AEG).Methods 110 patients who underwent AEG resection and lymph node dissection from December 2021 to December 2023 were selected and divided into laparoscopic group (n=62) and thoracoscopic laparoscopic combined group (n=48) according to treatment methods.After propensity score matching (PSM) was used to balance the difference between the two groups and reduce potential confounding factors,the general data,perioperative indexes,nutritional status indexes,postoperative complications,and postoperative survival of the two groups were analyzed.The generalized estimating equation (GEE) analysis was used to construct the nutritional status related index model of the two groups of patients before and after treatment.The Cox proportional risk model was used to analyse the effect of treatment on the prognosis of AEG patients.Results Before PSM,there were statistically significant differences in gender,age,body mass index (BMI),TNM grade,maximum tumor diameter and esophageal invasion length between the laparoscopic group and the thoracoscopic laparoscopic combined group (P<0.05).After PSM,the results showed that there were no statistical significances in the comparison of general clinical data between the laparoscopic group and thoracoscopic laparoscopic combined group (P>0.05).The operation time,postoperative bed time and postoperative hospital stay in the thoracoscopic laparoscopic combined group were significantly longer than those in the laparoscopic group (P<0.05),the intraoperative blood loss was significantly more than that in the laparoscopic group (P<0.05),and 24 h postoperative visual analogue scale (VAS) was significantly higher than that of laparoscopic group (P<0.05).The number of lymph node dissection,the number of positive lymph nodes,the number of mediastinal lymph nodes dissection and the number of abdominal lymph nodes dissection were significantly more than those in the laparoscopic group (P<0.05).The differences of hemoglobin (Hb),albumin (ALB),prealbumin (PAB),transferrin (TRF) and weight (W) before and after surgery were significantly higher than those in laparoscopic group (P<0.05).And there were no statistically significant differences in postoperative complications and 1-year survival rate between the two groups (P>0.05).The GEE analysis results showed that laparoscopic treatment had a greater impact on Hb and TRF,while thoracoscopic laparoscopic combined treatment had a greater impact on ALB,PAB and W.Laparoscopic treatment was a protective factor for good prognosis in AEG patients (P<0.05).Conclusion The laparoscopic treatment has advantages in operation time,postoperative bed time,postoperative hospital stay,intraoperative blood loss,24 h VAS and postoperative nutritional indexes.The thoracoscopic laparoscopic combined treatment has advantages in the number of lymph node dissection,the number of positive lymph node,the number of mediastinal lymph nodes dissection and the number of abdominal lymph nodes dissection.Considering the therapeutic effect comprehensively,the short-term prognosis of laparoscopic treatment is better.
