Laparoscopic versus open distal gastrectomy for locally advanced gastric cancer in middle-low-volume centers in Western countries: a propensity score matching analysis
Laparoscopic versus open distal gastrectomy for locally advanced gastric cancer in middle-low-volume centers in Western countries: a propensity score matching analysis
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DOI：
10.1007/s00423-020-01951-7
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发表时间：
2020-08-04
影响因子：
2.3
通讯作者：
Masoni, Luigi
中科院分区：
文献类型：
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作者：
Garbarino, Giovanni Maria;Costa, Gianluca;Masoni, Luigi
背景胃切除加D2淋巴结清扫是可切除胃癌的标准治疗方法。腹腔镜远端胃切除术(LDG)是早期胃癌的常规手术方式，甚至对局部进展期的胃癌，其适应证也在增加。这项研究的目的是比较西方国家的两个中低量中心在手术和肿瘤学结果方面对LDG和开放远端胃切除术(ODG)治疗局部进展期胃癌的经验。方法我们回顾了2009年至2014年连续123例接受LDG和ODG并D2淋巴清扫的患者的资料。其中，91个符合纳入条件(46个LDG和45个ODG)。在倾向得分匹配分析后，采用1：1病例对照匹配，将34名患者按每组进行分层。结果LDG组平均手术时间明显长于对照组(257.2 vs 197.2，p<；0.001)。两组在术中失血量、平均淋巴结清除量和淋巴结转移方面没有差异。两组术后并发症发生率相当。低分子肝素组大鼠的肠道通畅率和口服软化时间显著加快(p<；0.001)。腹腔镜组患者的5年总生存率和无瘤生存率较高，但后分组分析显示，LDG的优势仅在N0期和IB-II期患者中显著，而N+和III期患者的生存曲线完全重叠。结论LDG治疗局部进展期胃癌似乎是可行和安全的，其手术和长期肿瘤学结果与开腹手术相当，即使是在中低量中心。
Background Gastrectomy with D2 lymphadenectomy is the standard treatment for patients with resectable gastric cancer. Laparoscopic distal gastrectomy (LDG) is routinely performed for early gastric cancer, and its indications are increasing even for locally advanced gastric cancer. The aim of this study is to compare two middle-low-volume centers in Western countries experience on LDG versus open distal gastrectomy (ODG) for locally advanced gastric cancer in terms of surgical and oncological outcomes. Methods We reviewed the data of 123 consecutive patients that underwent LDG and ODG with D2 lymphadenectomy between 2009 and 2014. Among them, 91 were eligible for inclusion (46 LDG and 45 ODG). After propensity score matching analysis, using a 1:1 case-control match, 34 patients were stratified for each group. Results The mean operative time was significantly longer in the LDG group (257.2 vs. 197.2,p < 0.001). No differences were observed in terms of intraoperative blood loss, average number of lymph nodes removed, and lymph node metastases. The postoperative morbidity was comparable in the two groups. LDG group had a significant faster bowel canalization and soft oral intake (p < 0.001). The 5-year overall and disease-free survival were higher for patients treated by laparoscopy, but the post-hoc subgroups analysis revealed that the advantage of LDG was significant just in N0 and stage IB-II patients, whereas N+ and stage III patient's survival curves were perfectly superimposable. Conclusions LDG for locally advanced gastric cancer seems to be feasible and safe with surgical and long-term oncological outcomes comparable with open surgery, even in medium-low-volume centers.