食管胃结合部癌与手术

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SiewertⅠ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；
SiewertⅡ型距病变上缘5厘米的食管下段切 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；
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Conclusion
there were no significant differences of survival rate, postoperative morbidity and mortality between transthoracic resection group and non-transthoracic resection group.
9ቤተ መጻሕፍቲ ባይዱ
hospital stay time (C) hospital deaths (D)
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randomized controlled trials (A) non-randomized controlled trials (B)
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anastomotic leak (A)
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pulmonary complications (B) cardiovascular complications (C)
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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 Ⅱ and Ⅲ tumors;
Transthoracic vs transhiatal surgery for cancer of the esophagogastric junction
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distal esophageal adenocarcinomas (AEGⅠ) true cardia carcinomas (AEG Ⅱ) subcardiac gastric cancers (AEG Ⅲ).
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THANKS!
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A: All Siewert types B: Siewert Ⅰ
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C: Siewert Ⅱ; D: Siewert Ⅲ
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CONCLUSION
The results indicated a shorter hospital stay, lower 30-d hospital mortality and decreased pulmonary complications with the transhiatal approach compared with the transthoracic approach. Moreover, a potential survival benefit was achieved for type Ⅲ tumors using the transhiatal approach.
SiewertⅢ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。
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surgical time (A) blood loss (B),