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Abstract：
BACKGROUND: Laparoscopic gastrectomy for esophagogastric junction (EGJ) carcinoma enables the removal of the carcinoma at the junction between the stomach and esophagus while preserving the gastric function, thereby providing patients with better treatment outcomes and quality of life. Nonetheless, this surgical technique also presents some challenges and limitations. Therefore, three-dimensional reconstruction visualization technology (3D RVT) has been introduced into the procedure, providing doctors with more comprehensive and intuitive anatomical information that helps with surgical planning, navigation, and outcome evaluation.
OBJECTIVE: To discuss the application and advantages of 3D RVT in precise laparoscopic resection of EGJ carcinomas.
METHODS: Data were obtained from the electronic or paper-based medical records at The First Affiliated Hospital of Hebei North University from January 2020 to June 2022. A total of 120 patients diagnosed with EGJ carcinoma were included in the study. Of these, 68 underwent laparoscopic resection after computed tomography (CT)-enhanced scanning and were categorized into the 2D group, whereas 52 underwent laparoscopic resection after CT-enhanced scanning and 3D RVT and were categorized into the 3D group. This study had two outcome measures: the deviation between tumor-related factors (such as maximum tumor diameter and infiltration length) in 3D RVT and clinical reality, and surgical outcome indicators (such as operative time, intraoperative blood loss, number of lymph node dissections, R0 resection rate, postoperative hospital stay, postoperative gas discharge time, drainage tube removal time, and related complications) between the 2D and 3D groups.
RESULTS: Among patients included in the 3D group, 27 had a maximum tumor diameter of less than 3 cm, whereas 25 had a diameter of 3 cm or more. In actual surgical observations, 24 had a diameter of less than 3 cm, whereas 28 had a diameter of 3 cm or more. The findings were consistent between the two methods (χ2 = 0.346, P = 0.556), with a kappa consistency coefficient of 0.808. With respect to infiltration length, in the 3D group, 23 patients had a length of less than 5 cm, whereas 29 had a length of 5 cm or more. In actual surgical observations, 20 cases had a length of less than 5 cm, whereas 32 had a length of 5 cm or more. The findings were consistent between the two methods (χ2 = 0.357, P = 0.550), with a kappa consistency coefficient of 0.486. Pearson correlation analysis showed that the maximum tumor diameter and infiltration length measured using 3D RVT were positively correlated with clinical observations during surgery (r = 0.814 and 0.490, both P < 0.05). The 3D group had a shorter operative time (157.02 ± 8.38 vs 183.16 ± 23.87), less intraoperative blood loss (83.65 ± 14.22 vs 110.94 ± 22.05), and higher number of lymph node dissections (28.98 ± 2.82 vs 23.56 ± 2.77) and R0 resection rate (80.77% vs 61.64%) than the 2D group. Furthermore, the 3D group had shorter hospital stay [8 (8, 9) vs 13 (14, 16)], time to gas passage [3 (3, 4) vs 4 (5, 5)], and drainage tube removal time [4 (4, 5) vs 6 (6, 7)] than the 2D group. The complication rate was lower in the 3D group (11.54%) than in the 2D group (26.47%) (χ2 = 4.106, P < 0.05).
CONCLUSIONS: Using 3D RVT, doctors can gain a more comprehensive and intuitive understanding of the anatomy and related lesions of EGJ carcinomas, thus enabling more accurate surgical planning.
OBJECTIVE: To discuss the application and advantages of 3D RVT in precise laparoscopic resection of EGJ carcinomas.
METHODS: Data were obtained from the electronic or paper-based medical records at The First Affiliated Hospital of Hebei North University from January 2020 to June 2022. A total of 120 patients diagnosed with EGJ carcinoma were included in the study. Of these, 68 underwent laparoscopic resection after computed tomography (CT)-enhanced scanning and were categorized into the 2D group, whereas 52 underwent laparoscopic resection after CT-enhanced scanning and 3D RVT and were categorized into the 3D group. This study had two outcome measures: the deviation between tumor-related factors (such as maximum tumor diameter and infiltration length) in 3D RVT and clinical reality, and surgical outcome indicators (such as operative time, intraoperative blood loss, number of lymph node dissections, R0 resection rate, postoperative hospital stay, postoperative gas discharge time, drainage tube removal time, and related complications) between the 2D and 3D groups.
RESULTS: Among patients included in the 3D group, 27 had a maximum tumor diameter of less than 3 cm, whereas 25 had a diameter of 3 cm or more. In actual surgical observations, 24 had a diameter of less than 3 cm, whereas 28 had a diameter of 3 cm or more. The findings were consistent between the two methods (χ2 = 0.346, P = 0.556), with a kappa consistency coefficient of 0.808. With respect to infiltration length, in the 3D group, 23 patients had a length of less than 5 cm, whereas 29 had a length of 5 cm or more. In actual surgical observations, 20 cases had a length of less than 5 cm, whereas 32 had a length of 5 cm or more. The findings were consistent between the two methods (χ2 = 0.357, P = 0.550), with a kappa consistency coefficient of 0.486. Pearson correlation analysis showed that the maximum tumor diameter and infiltration length measured using 3D RVT were positively correlated with clinical observations during surgery (r = 0.814 and 0.490, both P < 0.05). The 3D group had a shorter operative time (157.02 ± 8.38 vs 183.16 ± 23.87), less intraoperative blood loss (83.65 ± 14.22 vs 110.94 ± 22.05), and higher number of lymph node dissections (28.98 ± 2.82 vs 23.56 ± 2.77) and R0 resection rate (80.77% vs 61.64%) than the 2D group. Furthermore, the 3D group had shorter hospital stay [8 (8, 9) vs 13 (14, 16)], time to gas passage [3 (3, 4) vs 4 (5, 5)], and drainage tube removal time [4 (4, 5) vs 6 (6, 7)] than the 2D group. The complication rate was lower in the 3D group (11.54%) than in the 2D group (26.47%) (χ2 = 4.106, P < 0.05).
CONCLUSIONS: Using 3D RVT, doctors can gain a more comprehensive and intuitive understanding of the anatomy and related lesions of EGJ carcinomas, thus enabling more accurate surgical planning.
摘要：
背景：腹腔镜胃切除术治疗食管胃结合部（EGJ）癌可以在保留胃功能的同时切除胃和食管结合部的癌，从而为患者提供更好的治疗结果和生活质量。尽管如此，这种手术技术也带来了一些挑战和局限性.因此,将三维重建可视化技术(3DRVT)引入到程序中,为医生提供更全面和直观的解剖信息，有助于手术计划，导航,和结果评估。
目的：探讨3DRVT在腹腔镜精准切除EGJ癌中的应用及优势。
方法：数据来自河北北方大学附属第一医院2020年1月至2022年6月的电子或纸质病历。总共120例诊断为EGJ癌的患者被纳入研究。其中,68例患者在计算机断层扫描（CT）增强扫描后接受了腹腔镜切除术，并被归类为2D组，52例患者在CT增强扫描和3DRVT后接受了腹腔镜切除术,并被归类为3D组.这项研究有两个结果指标：3DRVT中肿瘤相关因素（如最大肿瘤直径和浸润长度）与临床现实之间的偏差，和手术结果指标(如手术时间，术中失血,淋巴结清扫的数量，R0切除率,术后住院时间,术后气体排出时间,引流管拔除时间,和相关并发症）在2D和3D组之间。
结果：在纳入3D组的患者中，27个肿瘤的最大直径小于3厘米，而25个直径为3厘米或更大。在实际的手术观察中，24的直径小于3厘米，而28的直径为3厘米或更大。两种方法的结果一致(χ2=0.346,P=0.556),Kappa一致性系数为0.808。关于渗透长度，在3D组中，23名患者的长度小于5厘米，而29的长度为5厘米或更长。在实际的手术观察中，20例长度小于5厘米，而32的长度为5厘米或更长。两种方法的结果一致(χ2=0.357,P=0.550),Kappa一致性系数为0.486。Pearson相关性分析显示，3DRVT测得的肿瘤最大直径和浸润长度与术中临床观察呈正相关（r=0.814和0.490，均P<0.05）。3D组手术时间较短（157.02±8.38vs183.16±23.87），术中出血量少（83.65±14.22vs110.94±22.05），淋巴结清扫数（28.98±2.82vs23.56±2.77）和R0切除率（80.77％vs61.64％）高于2D组。此外，3D组住院时间较短[8（8，9）vs13（14，16）]，气体通过时间[3（3，4）vs4（5，5）]，和引流管拔除时光[4(4，5)vs6(6，7)]比2D组。3D组并发症发生率(11.54%)低于2D组(26.47%)(χ2=4.106,P<0.05)。
结论：使用3DRVT，医生可以对EGJ癌的解剖结构和相关病变有更全面和直观的了解，从而实现更准确的手术计划。
目的：探讨3DRVT在腹腔镜精准切除EGJ癌中的应用及优势。
方法：数据来自河北北方大学附属第一医院2020年1月至2022年6月的电子或纸质病历。总共120例诊断为EGJ癌的患者被纳入研究。其中,68例患者在计算机断层扫描（CT）增强扫描后接受了腹腔镜切除术，并被归类为2D组，52例患者在CT增强扫描和3DRVT后接受了腹腔镜切除术,并被归类为3D组.这项研究有两个结果指标：3DRVT中肿瘤相关因素（如最大肿瘤直径和浸润长度）与临床现实之间的偏差，和手术结果指标(如手术时间，术中失血,淋巴结清扫的数量，R0切除率,术后住院时间,术后气体排出时间,引流管拔除时间,和相关并发症）在2D和3D组之间。
结果：在纳入3D组的患者中，27个肿瘤的最大直径小于3厘米，而25个直径为3厘米或更大。在实际的手术观察中，24的直径小于3厘米，而28的直径为3厘米或更大。两种方法的结果一致(χ2=0.346,P=0.556),Kappa一致性系数为0.808。关于渗透长度，在3D组中，23名患者的长度小于5厘米，而29的长度为5厘米或更长。在实际的手术观察中，20例长度小于5厘米，而32的长度为5厘米或更长。两种方法的结果一致(χ2=0.357,P=0.550),Kappa一致性系数为0.486。Pearson相关性分析显示，3DRVT测得的肿瘤最大直径和浸润长度与术中临床观察呈正相关（r=0.814和0.490，均P<0.05）。3D组手术时间较短（157.02±8.38vs183.16±23.87），术中出血量少（83.65±14.22vs110.94±22.05），淋巴结清扫数（28.98±2.82vs23.56±2.77）和R0切除率（80.77％vs61.64％）高于2D组。此外，3D组住院时间较短[8（8，9）vs13（14，16）]，气体通过时间[3（3，4）vs4（5，5）]，和引流管拔除时光[4(4，5)vs6(6，7)]比2D组。3D组并发症发生率(11.54%)低于2D组(26.47%)(χ2=4.106,P<0.05)。
结论：使用3DRVT，医生可以对EGJ癌的解剖结构和相关病变有更全面和直观的了解，从而实现更准确的手术计划。
