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1、Transthoracic vs transhiatal surgery for cancer of theesophagogastric junction,胸外二科 鲁方亮2014-10-24,1,2,distal esophageal adenocarcinomas(AEG)true cardia carcinomas(AEG)subcardiac gastric cancers(AEG).,3,Siewert型主要反映出来的是食管下段的病变，故以据病变上缘5-10厘米的部分食管和距病变下缘5厘米的近端胃行切除术，手术入路以经右或左开胸进行为宜；,Siewert型距病变上缘5厘米的食管下段
2、切除，下缘可行近端胃大部切除或全胃切除术，手术入路以腹-胸两切口或胸腹联合切口为宜；,Siewert型则为全胃切除和距病变上缘5厘米的食管下段切除术，手术操作主要在腹部，是否需要做全胃切除尚存有争议，特别是早期病变。对于病变局限于黏膜或黏膜下，并且无淋巴结转移的证据，可考虑行近端胃切除术而取代全胃切除术，但其缺点经常造成胃食管返流以及不同程度的食管炎。,7,8,surgical time(A)blood loss(B),9,hospital stay time(C)hospital deaths(D),10,randomized controlled trials(A)non-randomiz
3、ed controlled trials(B),11,anastomotic leak(A),12,pulmonary complications(B)cardiovascular complications(C),13,A:All Siewert types B:Siewert,14,C:Siewert;D:Siewert,15,CONCLUSION,The results indicated a shorter hospital stay,lower 30-d hospital mortality and decreased pulmonary complications with the
4、 transhiatal approach compared with the transthoracic approach.Moreover,a potential survival benefit was achieved for type tumors using the transhiatal approach.,16,17,18,Conclusion,there were no significant differences of survival rate,postoperative morbidity and mortality between transthoracic res
5、ection group and non-transthoracic resection group.,19,Questions,Transthoracic:left thoracic,right thoracic,thoracoabdominal approaches;The optimum extent of lymph node resection is still controversial;OS:recommend the transthoracic approach as the preferred option for type I tumors and the transhiatal approach for type and tumors;,20,THANKS!,21,
