Objective To compare the clinical outcomes of patients with cardiac cancer undergoing radical resection by laparotomy or thoracotomy. Methods A total of 198 patients with cardiac cancer were selected from January 2014 to December 2017. Among them, 108 patients in the study group received trans-abdominal cancer resection and 90 patients in the control group received trans-thoracic cancer resection. General clinical characteristics, surgery time, intraoperative and postoperative hemorrhage volumes, postoperative complications, lymph nodes resection rate, positive surgical margins, tumor node metastasis （TNM） stages, hospital mortality rate, hospital stay, and 5-year survival were compared between the two groups. Results No significant difference was found in general clinical characteristics （P>0.05）. Compared with the control group, the surgery time, intraoperative and postoperative hemorrhage volumes, postoperative complication rate, lymph nodes resection rate, and hospital stay were superior in the study group （P<0.05）. No difference in positive surgical margin rate was found between the two groups, both with complete resection. There was no significant difference in 5-year survival rate between the two groups （P>0.05）. Conclusion Complications more frequently happen, operative trauma is larger, and 5-year survival is not increased after trans-thoracic cardiac cancer resection, though more esophagus and mediastinal lymph nodes can be removed. Therefore, trans-abdominal cardiac cancer resection is recommended.
YUAN Ronghua
,
YU Xiaoqiang
,
WANG Chunzhan
,
XIA Chunqiu
,
ZHONG Chongjun
,
HUANG Haitao
. Comparative study of clinical outcomes of different surgical approaches for cardiac cancer[J]. Surgical Research and New Technique, 2022
, 11(4)
: 227
-231
.
DOI: 10.3969/j.issn.2095-378X.2022.04.002
[1] Hasegawa S, Yoshikawa T.Adenocarcinoma of the esophagogastric junction: incidence, characteristics, and treatment strategies[J]. Gastric Cancer, 2010,13(2): 63-73.
[2] Kurokawa Y, Sasako M, Doki Y.Treatment approaches to esophagogastric junction tumors[J]. Dig Surg, 2013,30(2):169-173.
[3] Jung KW, Song HJ, Choi KD, et al.Unchanging trend of esophagogastric junction adenocarcinoma in Korea: experience at a single institution based on Siewert's classification[J]. Dis Esophagus,2009,22(8):676-681.
[4] Orditura M, Galizia G, Lieto E, et al.Treatment of esophagogastric junction carcinoma: an unsolved debate[J]. World J Gastroenterol, 2015,21(15):4427-4431.
[5] Tang A, Sohal D, McNamara M, et al. Siewert Ⅲ adenocarcinoma: still searching for the right treatment combination[J]. Surg Oncol Clin N Am, 2020,29(4):647-653.
[6] Siewert JR, Feith M, Werner M, et al.Adenocarcinoma of the esophagogastric junction[J]. Scand J Surg, 2000, 232(3): 353-361.
[7] Urabe M, Ushiku T, Shinozaki-Ushiku A, et al.Adenocarcinoma of the esophagogastric junction and its background mucosal pathology: a comparative analysis according to Siewert classification in a Japanese cohort[J]. Cancer Med, 2018,7(10):5145-5154.
[8] Urakawa N, Kanaji S, Suzuki S, et al.Prognostic and clinicopathological significance of lymph node metastasis in the esophagogastric junction adenocarcinoma[J]. Anticancer Res, 2022,42(2):1051-1057.
[9] Mitchell KG, Ikoma N, Nelson DB, et al.Mediastinal nodal involvement after neoadjuvant chemoradiation for Siewert Ⅱ/Ⅲ adenocarcinoma[J]. Ann Thorac Surg, 2019,108(3):845-851.
[10] Hölscher AH, Law S.Esophagogastric junction adenocarcinomas: individualization of resection with special considerations for Siewert type Ⅱ, and Nishi types EG, E=G and GE cancers[J]. Gastric Cancer, 2020,23(1):3-9.
[11] Cao J, Yang T, Wang G, et al.Analysis of the clinicopathological features and prognostic factors in 734 cases of Chinese Hui and Han patients with adenocarcinoma of the esophagogastric junction[J]. Surg Oncol, 2018 ,27(3):556-562.
[12] Siewert JR, Feith M, Stein HJ.Biologic and clinical variations of adenocarcinoma at the esophago-gastric junction: relevance of a topographic-anatomic subclassification[J]. J Surg Oncol, 2005,90(3):139-146.
[13] Sugita S, Kinoshita T, Kaito A, et al.Short-term outcomes after laparoscopic versus open transhiatal resection of Siewert type Ⅱ adenocarcinoma of the esophagogastric junction[J]. Surg Endosc, 2018,32(1):383-390.
[14] 尤朵,赵学科,魏梦霞,等.贲门癌患者术前白蛋白水平与临床病理指标及预后的关系[J].食管疾病,2022,4(1):37-41.
[15] Raa ST, Oosterling SJ, van der Kaaij NP, et al. Surgery promotes implantation of disseminated tumor cells, but does not increase growth of tumor cell clusters[J]. J Surg Oncol, 2005, 92(2): 124-129.
[16] 黄洁,汪海峡.不同入路下根治术对高龄贲门癌患者围手术期指标及免疫功能的影响[J].现代实用医学,2019,31(12):1576-1578.
[17] 李爱华,闫元,龚云翔.经腹与经胸贲门癌根治术治疗贲门癌患者的效果及对免疫功能的影响[J].中外医学研究,2022,20(6):37-40.
[18] Tai LH, de Souza CT, Bélanger S, et al. Preventing postoperative metastatic disease by inhibiting surgery-induced dysfunction in natural killer cells[J]. Cancer Res, 2013, 73(1):97-107.
