新辅助免疫治疗对Siewert Ⅱ/Ⅲ型食管胃结合部腺癌腹腔镜根治术后肺部并发症的影响OA

Objective:To investigate the impact of neoadjuvant immunotherapy on short-term postoperative pulmonary compli-cations in patients with Siewert typeⅡ/Ⅲadenocarcinoma of the esophagogastric junction(AEG)undergoing laparoscopic radical re-section.Methods:Clinical data of patients with Siewert typeⅡ/ⅢAEG who received neoadjuvant therapy combined with laparoscopic radical gastrectomy from Jan.2020 to Dec.2024 were retrospectively analyzed.Patients were divided into observation group(neoadju-vant immunotherapy combined with chemotherapy,n=48)and the control group(neoadjuvant chemotherapy alone,n=50)based on whether immunotherapy was combined.The incidence of short-term postoperative complications and postoperative survival rates were compared between the two groups.Results:A total of 98 patients were enrolled,with no statistically significant differences in preopera-tive baseline data between the two groups(P>0.05).The pathological complete response rate(22.9%vs.8.0%,P=0.04)and the incidence of postoperative pleural effusion(47.9%vs.24.0%,P=0.01)in the observation group were significantly higher than those in the control group.Univariate and multivariate logistic regression analysis revealed that preoperative neoadjuvant immunotherapy was a risk factor for postoperative pleural effusion(OR=3.501,95%CI=1.353～9.059,P=0.01).There were no statistically significant differences in 3-year overall survival rate and disease-free survival rate between the two groups(P>0.05).Conclusions:Laparoscopic radical gastrectomy following neoadjuvant immunotherapy combined with chemotherapy is safe and feasible for advanced Siewert typeⅡ/Ⅲ AEG.However,close attention should be paid to the management of postoperative pulmonary complications,especially pleural effusion.Timely imaging examination is required for diagnosis,and thoracentesis and catheter drainage should be performed when neces-sary.