内镜超声在食管癌术前TN分期中的诊断价值

Different surgical approaches for adenocarcinoma of the esophagogastric junction

AIM: To investigate the therapeutic effects of different surgical approaches for adenocarcinoma of the esophagogastric junction (AEG).

METHODS: One hundred and fifty AEG patients were randomly divided into either an experimental group or a control group. The experimental group underwent surgery via a transabdominal approach, while the control group was treated via a transthoracic approach. The operation situation, postoperative pathology and complications were compared between the two groups.

RESULTS: There were significant differences in mean operative time (187.42 min ± 48.47 min vs 225.79 min ± 83.98 min), mean blood loss (128.09 mL ± 48.95 mL vs 208.01 mL ± 70.12 mL), number of paraesophageal lymph nodes (0.18 ± 0.67 vs 0.18 ± 0.67), number of cleared lymph nodes (12.71 ± 7.19 vs 8.20 ± 5.31), number of lymph nodes in the lesser curvature (6.51 ± 3.09 vs 1.72 ± 1.83), number of paraesophageal lymph nodes (12 vs 44), and number of cleared lymph nodes in the lesser curvature (330 vs 102) between the experimental group and control group (All I < 0.05). No significant difference was noted in the rate of positive margins (14.66% vs 10.66%, P > 0.05) between the two groups. The rate of positive curvature lymph nodes in the lesser curvature was significantly higher than that in the periesophagus in both groups (75.76% vs 11.11%, 66.04% vs 22.73%). No anastomotic fistula occurred in either group, although the complication rate was lower in the experimental group than in the control group (2.67% vs 14.67%, P < 0.05).

CONCLUSION: Transabdominal surgery can clear more lymph nodes than transthoracic surgery. Total gastrectomy does better in the clearance of perigastric lymph nodes, especially those in the lesser curvature.

Multivariate logistic regression analysis of risk factors for complications after esophagectomy for esophageal cancer and establishment of a discriminant model

AIM: To investigate the main risk factors for complications after esophagectomy for esophageal cancer and to establish a logistic regression model to predict these complications.

METHODS: The clinical data for patients with esophageal cancer patients (n = 1197) who underwent esophagectomy between January 1997 and December 2010 were analyzed retrospectively. Logistic regression analysis was performed to investigate the risk factors for postoperative complications in these patients.

RESULTS: Postoperative severe complications were associated with age, chronic obstructive pulmonary disease (COPD), diabetes mellitus, heart diseases, surgeon volume, position of the anastomotic stoma, operative time, blood loss, invasion to the adjacent organ, and TNM stage III. The logistic regression equation was P = 1/[1+e^{(18.629-0.223X1-2.418X2-0.885X3-1.760X4-1.549X5-0.779X6-0.939X7-1.072X8-1.195X9-0.916X10)}]. The accuracy, sensitivity and specificity of the logistic model for discriminating testing samples were 74.0%, 67.9% and 81.8%, respectively.

CONCLUSION: Age, COPD, diabetes mellitus, heart diseases, surgeon volume, position of the anastomotic stoma, operative time, blood loss, invasion to the adjacent organ, TNM stage III are independent risk factors for complications after esophagectomy for esophageal cancer. The logistic regression model established based on these factors is reliable in predicting these complications.