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Sun CB, Han XQ, Wang H, Zhang YX, Wang MC, Liu YN. Effect of two surgical approaches on the lung function and prognosis of patients with combined esophagogastric cancer. World J Gastrointest Surg 2023; 15:1986-1994. [PMID: 37901732 PMCID: PMC10600760 DOI: 10.4240/wjgs.v15.i9.1986] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 05/24/2023] [Revised: 07/04/2023] [Accepted: 07/31/2023] [Indexed: 09/21/2023] Open
Abstract
BACKGROUND Adenocarcinoma of the esophagogastric junction has a center of origin within 5 cm of the esophagogastric junction. Surgical resection remains the main treatment. A transthoracic approach is recommended for Siewert I adenocarcinoma of the esophagogastric junction and a transabdominal approach is recommended for Siewert III adenocarcinoma of the esophagogastric junction. However, there is a need to determine the optimal surgical approach for Siewert II adenocarcinoma of the esophagogastric junction to improve lung function and the prognosis of patients. AIM To investigate and compare the surgical effects, postoperative changes in pulmonary function, and prognoses of two approaches to treating combined esophagogastric cancer. METHODS One hundred and thirty-eight patients with combined esophagogastric cancer treated by general and thoracic surgeries in our hospital were selected. They were divided into group A comprising 70 patients (transabdominal approach) and group B comprising 68 patients (transthoracic approach) based on the surgical approach. The indexes related to surgical trauma, number of removed lymph nodes, indexes of lung function before and after surgery, survival rate, and survival duration of the two groups were compared 3 years after surgery. RESULTS The duration of surgery, length of hospital stay, and postoperative drainage duration of the patients in group A were shorter than those of the patients in group B, and the volume of blood loss caused by surgery was lower for group A than for group B (P < 0.05). At the one-month postoperative review, the first second, maximum ventilation volume, forceful lung volume, and lung volume values were higher for group A than for group B (P < 0.05). Preoperatively, the QLQ-OES18 scale scores of the patients in group A were higher than those in group B on re-evaluation at 3 mo postoperatively (P < 0.05). The surgical complication rate of the patients in group A was 10.00%, which was lower than that of patients in group B, which was 23.53% (P < 0.05). CONCLUSION Transabdominal and transthoracic surgical approaches are comparable in treating combined esophagogastric cancer; however, the former results in lesser surgical trauma, milder changes in pulmonary function, and fewer complications.
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Affiliation(s)
- Chong-Bing Sun
- Department of General Surgery, Weifang People's Hospital, Weifang 261041, Shandong Province, China
| | - Xiao-Qing Han
- Department of Spinal Surgery, Weifang People's Hospital, Weifang 261041, Shandong Province, China
| | - Hao Wang
- Department of General Surgery, Weifang People's Hospital, Weifang 261041, Shandong Province, China
| | - Yi-Xuan Zhang
- Department of Medical, Weifang People's Hospital, Weifang 261041, Shandong Province, China
| | - Meng-Chun Wang
- Department of General Surgery, Weifang People's Hospital, Weifang 261041, Shandong Province, China
| | - Yong-Ning Liu
- Department of General Surgery, Weifang People's Hospital, Weifang 261041, Shandong Province, China
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Tanaka T, Arigami T, Uenosono Y, Yanagita S, Matsushita D, Okubo K, Kijima T, Uchikado Y, Kita Y, Mori S, Sasaki K, Omoto I, Kurahara H, Maemura K, Ishigami S, Natsugoe S. A long-term survivor of recurrent esophagogastric junction adenocarcinoma treated with multidisciplinary therapy: a case report. Surg Case Rep 2020; 6:13. [PMID: 31919764 PMCID: PMC6952476 DOI: 10.1186/s40792-020-0776-5] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 09/07/2019] [Accepted: 12/31/2019] [Indexed: 12/04/2022] Open
Abstract
Background Patients with esophagogastric junction cancer are increasing in Western and Eastern countries. Conversely, the clinical significance of surgical resection remains controversial in these patients. We report a long-term survivor of recurrent esophagogastric junction adenocarcinoma who underwent constructive multimodal therapy, including surgical resection. Case presentation A 51-year-old man underwent total gastrectomy for esophagogastric junction adenocarcinoma in 2009. In June 2010, computed tomography (CT) indicated a lung nodule and we partially resected the right lower lung. It was pathologically diagnosed as distant metastasis from esophagogastric junction cancer. After lung resection, he received adjuvant chemotherapy with S-1 for 1 year. In September 2014, CT demonstrated a swelling of the upper mediastinal lymph node with abnormal uptake on fluorine-18 fluorodeoxyglucose positron emission tomography. We performed an ultrasonography-guided needle biopsy, and he was diagnosed with lymph nodal recurrence of esophagogastric junction adenocarcinoma by pathological examination and was subsequently treated with capecitabine plus cisplatin plus trastuzumab. Since CT showed a reduction in the metastatic upper mediastinal lymph node after chemotherapy, he underwent upper mediastinal lymphadenectomy in April 2015. Following surgery, we provided radiation therapy to the upper mediastinum and chemotherapy with S-1. At the last report, the patient was alive for 8 years and 3 months since the first surgery. Conclusions This case report shows the clinical benefit of constructive multimodal therapy for recurrent esophagogastric junction adenocarcinoma.
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Affiliation(s)
- Takako Tanaka
- Department of Digestive Surgery, Breast and Thyroid Surgery, Kagoshima University Graduate School of Medical and Dental Sciences, 35-1, Sakuragaoka 8 cho-me, Kagoshima City, Kagoshima, 890-8520, Japan.
| | - Takaaki Arigami
- Department of Onco-biological Surgery, Kagoshima University Graduate School of Medical and Dental Sciences, 35-1, Sakuragaoka 8 cho-me, Kagoshima City, Kagoshima, 890-8520, Japan
| | - Yoshikazu Uenosono
- Department of Digestive Surgery, Breast and Thyroid Surgery, Kagoshima University Graduate School of Medical and Dental Sciences, 35-1, Sakuragaoka 8 cho-me, Kagoshima City, Kagoshima, 890-8520, Japan
| | - Shigehiro Yanagita
- Department of Digestive Surgery, Breast and Thyroid Surgery, Kagoshima University Graduate School of Medical and Dental Sciences, 35-1, Sakuragaoka 8 cho-me, Kagoshima City, Kagoshima, 890-8520, Japan
| | - Daisuke Matsushita
- Department of Digestive Surgery, Breast and Thyroid Surgery, Kagoshima University Graduate School of Medical and Dental Sciences, 35-1, Sakuragaoka 8 cho-me, Kagoshima City, Kagoshima, 890-8520, Japan
| | - Keishi Okubo
- Department of Digestive Surgery, Breast and Thyroid Surgery, Kagoshima University Graduate School of Medical and Dental Sciences, 35-1, Sakuragaoka 8 cho-me, Kagoshima City, Kagoshima, 890-8520, Japan
| | - Takashi Kijima
- Department of Digestive Surgery, Breast and Thyroid Surgery, Kagoshima University Graduate School of Medical and Dental Sciences, 35-1, Sakuragaoka 8 cho-me, Kagoshima City, Kagoshima, 890-8520, Japan
| | - Yasuto Uchikado
- Department of Digestive Surgery, Breast and Thyroid Surgery, Kagoshima University Graduate School of Medical and Dental Sciences, 35-1, Sakuragaoka 8 cho-me, Kagoshima City, Kagoshima, 890-8520, Japan
| | - Yoshiaki Kita
- Department of Digestive Surgery, Breast and Thyroid Surgery, Kagoshima University Graduate School of Medical and Dental Sciences, 35-1, Sakuragaoka 8 cho-me, Kagoshima City, Kagoshima, 890-8520, Japan
| | - Shinichiro Mori
- Department of Digestive Surgery, Breast and Thyroid Surgery, Kagoshima University Graduate School of Medical and Dental Sciences, 35-1, Sakuragaoka 8 cho-me, Kagoshima City, Kagoshima, 890-8520, Japan
| | - Ken Sasaki
- Department of Digestive Surgery, Breast and Thyroid Surgery, Kagoshima University Graduate School of Medical and Dental Sciences, 35-1, Sakuragaoka 8 cho-me, Kagoshima City, Kagoshima, 890-8520, Japan
| | - Itaru Omoto
- Department of Digestive Surgery, Breast and Thyroid Surgery, Kagoshima University Graduate School of Medical and Dental Sciences, 35-1, Sakuragaoka 8 cho-me, Kagoshima City, Kagoshima, 890-8520, Japan
| | - Hiroshi Kurahara
- Department of Digestive Surgery, Breast and Thyroid Surgery, Kagoshima University Graduate School of Medical and Dental Sciences, 35-1, Sakuragaoka 8 cho-me, Kagoshima City, Kagoshima, 890-8520, Japan
| | - Kosei Maemura
- Department of Digestive Surgery, Breast and Thyroid Surgery, Kagoshima University Graduate School of Medical and Dental Sciences, 35-1, Sakuragaoka 8 cho-me, Kagoshima City, Kagoshima, 890-8520, Japan
| | - Sumiya Ishigami
- Department of Digestive Surgery, Breast and Thyroid Surgery, Kagoshima University Graduate School of Medical and Dental Sciences, 35-1, Sakuragaoka 8 cho-me, Kagoshima City, Kagoshima, 890-8520, Japan
| | - Shoji Natsugoe
- Department of Digestive Surgery, Breast and Thyroid Surgery, Kagoshima University Graduate School of Medical and Dental Sciences, 35-1, Sakuragaoka 8 cho-me, Kagoshima City, Kagoshima, 890-8520, Japan.,Department of Onco-biological Surgery, Kagoshima University Graduate School of Medical and Dental Sciences, 35-1, Sakuragaoka 8 cho-me, Kagoshima City, Kagoshima, 890-8520, Japan
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