[Thoracoscopic laparoscopy-assisted Ivor-Lewis resection of esophagogastric junction cancer].

Objective: To investigate the outcome of patients with esophagogastric junction cancer undergoing thoracoscopic laparoscopy-assisted Ivor-Lewis resection. Methods: Eighty-four patients who were diagnosed with esophagogastric junction cancer and underwent Ivor-Lewis resection assisted by thoracoscopic laparoscopy at the National Cancer Center from October 2019 to April 2022 were collected. The neoadjuvant treatment mode, surgical safety and clinicopathological characteristics were analyzed. Results: Siewert type Ⅱ (92.8%) and adenocarcinoma (95.2%) were predominant in the cases. A total of 2 774 lymph nodes were dissected in 84 patients. The average number was 33 per case, and the median was 31. Lymph node metastasis was found in 45 patients, and the lymph node metastasis rate was 53.6% (45/84). The total number of lymph node metastasis was 294, and the degree of lymph node metastasis was 10.6%(294/2 774). Among them, abdominal lymph nodes (100%, 45/45) were more likely to metastasize than thoracic lymph nodes (13.3%, 6/45). Sixty-eight patients received neoadjuvant therapy before surgery, and nine patients achieved pathological complete remission (pCR) (13.2%, 9/68). Eighty-three patients had negative surgical margins and underwent R0 resection (98.8%, 83/84). One patient, the intraoperative frozen pathology suggested resection margin was negative, while vascular tumor thrombus was seen on the postoperative pathological margin, R1 resection was performed (1.2%, 1/84). The average operation time of the 84 patients was 234.5 (199.3, 275.0) minutes, and the intraoperative blood loss was 90 (80, 100) ml. One case of intraoperative blood transfusion, one case of postoperative transfer to ICU ward, two cases of postoperative anastomotic leakage, one case of pleural effusion requiring catheter drainage, one case of small intestinal hernia with 12mm poke hole, no postoperative intestinal obstruction, chyle leakage and other complications were observed. The number of deaths within 30 days after surgery was 0. Number of lymph nodes dissection, operation duration, and intraoperative blood loss were not related to whether neoadjuvant therapy was performed (P>0.05). Preoperative neoadjuvant chemotherapy combined with radiotherapy or immunotherapy was not related to whether postoperative pathology achieved pCR (P>0.05). Conclusion: Laparoscopic-assisted Ivor-Lewis surgery for esophagogastric junction cancer has a low incidence of intraoperative and postoperative complications, high safety, wide range of lymph node dissection, and sufficient margin length, which is worthy of clinical promotion.目的： 探讨胸腹腔镜辅助下Ivor-Lewis术式切除食管胃结合部癌的效果。 方法： 收集2019年10月至2022年4月期间在中国医学科学院肿瘤医院诊断为食管胃结合部癌并行胸腹腔镜辅助下Ivor-Lewis术式切除患者(84例)的相关资料，分析治疗模式及手术安全性。 结果： 84例患者中，以SiewertⅡ型(92.9%，78例)、腺癌(95.2%，80例)为主。84例患者术中共清扫淋巴结2 774枚，中位清扫淋巴结数为31枚(16~88枚)。45例患者有淋巴结转移，淋巴结转移率为53.6%(45/84)；全组患者淋巴结转移总数为294枚，淋巴结转移度为10.6%(294/2 774)。腹腔淋巴结(100%，45/45)较胸腔淋巴结(13.3%，6/45)更易转移。68例患者术前行新辅助治疗，术后病理达到病理完全缓解(pCR)9例(13.2%，9/68)。83例患者切缘阴性，R0切除率为98.8%(83/84)；1例患者术中冰冻切缘阴性，术后病理提示上切缘可见脉管瘤栓，为R1切除(1.2%，1/84)。84例患者的手术时长为234.5 min (199.3，275.0 min)，术中出血量为90 ml(80，100 ml)；术中输血1例，术后转入ICU病房1例，术后发生吻合口瘘2例，胸腔积液需要置管引流1例，12 mm戳卡孔小肠疝1例，无术后肠梗阻、乳糜胸等并发症，无术后30 d内死亡患者。淋巴结清扫数目、手术时长、术中出血量与是否行新辅助治疗无关(均P>0.05)，术前新辅助化疗是否联合放疗或免疫治疗与术后病理是否达到pCR无关(P>0.05)。 结论： 胸腹腔镜辅助下Ivor-Lewis术式切除食管胃结合部癌术中及术后并发症发生率较低，安全性较高，淋巴结清扫范围较广，切缘长度充分，值得临床推广。.