Objective: To compare the extent of lymphadenectomy and postoperative complications between Ivor-Lewis procedure and left sided thoracotomy in patients with Siewert type Ⅱ adenocarcinoma of the esophagogastric junction (AEG). Methods: The clinical data of 101 patients with Siewert type Ⅱ EG who received surgical treatment between January 2014 and September 2015 in the Department of Esophageal Cancer, Tianjin Medical University Cancer Hospital were analyzed retrospectively. These patients were divided into Ivor-Lewis group (IL, n=38) and left- sided thoracotomy group (LT, n=63) according to the operation mode. The number and extent of dissected lymph nodes and postoperative complications were compared between the two groups. Results: The surgical blood loss, length of postoperative stay, anastomotic leakage, pulmonary infection, respiratory failure and complications of incision of the two groups showed no significant differences (P>0.05 of all). The operation time of IL group was 200 min, significantly longer than the LT group (120 min, P<0.05). The number of resected lymph nodes in the IL and LT groups were (20±9) and (13±7), respectively, with a statistically significant difference (P<0.001). Significantly more thoracic lymph nodes (7±5) were harvested in the IL group than in the LT group (2±2, P<0.001), and the number of resected abdominal lymph nodes in the IL and LT groups were (13±8) and (11±7), with a non-significant difference (P=0.157). As regarding the lymph node dissection rate, the IL approach was obviously better than the LT approach in the following lymph node stations: superior mediastinal nodes, subcarinal nodes, left hilar nodes, right hilar nodes, middle thoracic paraesophageal nodes, lower thoracic paraesophageal nodes, lymph nodes along the common hepatic artery, and lymph nodes along the splenic artery(P<0.05 for all). Conclusions: The Ivor-Lewis procedure achieves better thoracic and abdominal lymph node dissection, and does not cause more postoperative complications than the left-sided thoracotomy in patients with Siewert type Ⅱ AEG. However, these findings need to be confirmed by large-scale randomized clinical trial in the future.
目的： 探讨SiewertⅡ型食管胃结合部腺癌(AEG)患者行Ivor－Lewis手术和传统左开胸手术在淋巴结清扫程度和术后并发症发生等方面的差异。 方法： 回顾性分析2014年1月至2015年9月于天津医科大学肿瘤医院食管肿瘤科行手术切除的101例SiewertⅡ型AEG患者的临床资料。根据手术方式分为Ivor－Lewis(IL)组(38例)和传统的左开胸(LT)组(63例)，比较两组患者的淋巴结清扫程度和术后并发症等方面的差异。 结果： IL组和LT组患者在手术出血量、术后住院时间、吻合口瘘、肺部感染及呼吸衰竭、切口液化或感染等并发症发生率方面的差异均无统计学意义(均P>0.05)。IL组患者的手术时间为200 min，明显长于LT组患者(120 min，P<0.05)。IL组和LT组患者分别清扫淋巴结(20±9)枚和(13±7)枚，差异有统计学意义(P<0.001)。IL组患者清扫胸腔淋巴结(7±5)枚，明显高于LT组患者[(2±2)枚，P<0.001]。IL组患者清扫腹腔淋巴结(13±8)枚，LT组患者清扫腹腔淋巴结(11±7)枚，差异无统计学意义(P＝0.157)。IL组患者的上纵隔、隆突下、左肺门、右肺门、中段食管旁、下段食管旁、肝动脉旁和脾动脉旁的淋巴结清扫率均明显优于LT组(均P<0.05)。 结论： Ivor－Lewis手术较传统的左开胸术不会增加SiewertⅡ型AEG患者围手术期并发症的发生率，且在胸腔、腹腔淋巴结清扫方面优于左开胸术，但仍需大样本随机对照试验验证。.
Keywords: Adenocarcinoma, Siewert type Ⅱ; Esophagogastric junction; Esophagus neoplasms; Lymph node dissection.