Retrospective Study
Copyright ©The Author(s) 2023. Published by Baishideng Publishing Group Inc. All rights reserved.
World J Gastrointest Surg. Sep 27, 2023; 15(9): 1986-1994
Published online Sep 27, 2023. doi: 10.4240/wjgs.v15.i9.1986
Effect of two surgical approaches on the lung function and prognosis of patients with combined esophagogastric cancer
Chong-Bing Sun, Xiao-Qing Han, Hao Wang, Yi-Xuan Zhang, Meng-Chun Wang, Yong-Ning Liu
Chong-Bing Sun, Hao Wang, Meng-Chun Wang, Yong-Ning Liu, 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
Yi-Xuan Zhang, Department of Medical, Weifang People's Hospital, Weifang 261041, Shandong Province, China
Author contributions: Sun CB and Liu YN designed the research study; Sun CB, Han XQ and Wang H performed the research; Zhang YX contributed new reagents and analytic tools; Wang MC and Sun CB analyzed the data and wrote the manuscript; All authors have read and approve the final manuscript.
Institutional review board statement: The study was reviewed and approved by the Weifang People's Hospital Institutional Review Board, No. AF/SQ-01/01.0.
Informed consent statement: All study participants or their legal guardian provided informed written consent about personal and medical data collection prior to study enrolment.
Conflict-of-interest statement: All the authors report no relevant conflicts of interest for this article.
Data sharing statement: No additional data are available.
Open-Access: This article is an open-access article that was selected by an in-house editor and fully peer-reviewed by external reviewers. It is distributed in accordance with the Creative Commons Attribution NonCommercial (CC BY-NC 4.0) license, which permits others to distribute, remix, adapt, build upon this work non-commercially, and license their derivative works on different terms, provided the original work is properly cited and the use is non-commercial. See: https://creativecommons.org/Licenses/by-nc/4.0/
Corresponding author: Yong-Ning Liu, MSc, Attending Doctor, Department of General Surgery, Weifang People's Hospital, No. 151 Kuiwen District, Weifang 261041, Shandong Province, China. rmyyliuyn@wfmc.edu.cn
Received: May 24, 2023
Peer-review started: May 24, 2023
First decision: June 13, 2023
Revised: July 4, 2023
Accepted: July 31, 2023
Article in press: July 31, 2023
Published online: September 27, 2023
Processing time: 121 Days and 11.7 Hours
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.

Keywords: Transabdominal approach; Transthoracic approach; Esophagogastric Junction cancer; Pulmonary function; Prognosis; Adenocarcinoma

Core Tip: Surgical resection remains the main treatment for adenocarcinoma of the esophagogastric junction. The transthoracic approach is recommended for Siewert I, and the transabdominal approach for Siewert III adenocarcinomas of the esophagogastric junction. However, the optimal surgical approach for Siewert II adenocarcinoma of the esophagogastric junction remains inconclusive. We found that the transabdominal approach has the advantage of lesser surgical trauma, lesser impact on patients' pulmonary function, and fewer complications.