Laparoscopy-Assisted vs. Open Total Gastrectomy for Advanced Gastric Cancer: Long-Term Outcomes and Technical Aspects of a Case-Control Study
Laparoscopy-Assisted vs. Open Total Gastrectomy for Advanced Gastric Cancer: Long-Term Outcomes and Technical Aspects of a Case-Control Study
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DOI：
10.1007/s11605-013-2218-1
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发表时间：
2013-07-01
影响因子：
3.2
通讯作者：
Huaxing, L.
中科院分区：
文献类型：
--
作者：
Bo, T.;Peiwu, Y.;Huaxing, L.
越来越多的研究比较了腹腔镜辅助下的远端胃切除术和传统的开放式远端胃切除术；证实了该技术的可行性和临床疗效。然而，很少有数据可以比较腹腔镜辅助全胃切除术（LATG）和开放技术治疗晚期胃癌（AGC）。本研究的目的是比较LATG与开放式全胃切除术（OTG）治疗AGC的肿瘤学疗效和长期结果，并就这些手术困难提供我们的经验。我们利用一个特殊外科团队在我科进行的所有手术的临床数据库中的数据，回顾性分析了2004年1月至2010年12月期间117例LATG和匹配的OTG的数据。该分析是一项病例对照研究，两组患者通过倾向评分匹配法根据肿瘤位置、年龄、性别、BMI和TNM分期进行匹配。比较两组患者的临床特点、淋巴结恢复情况、术后早期并发症、复发率及远期预后。两组患者的人口统计学、术前数据和肿瘤特征相似。与OTG组相比，LATG组在淋巴结数量或离近端边缘的距离方面没有显着差异。LATG组手术时间明显长于OTG组（292.8 +/- 49.5 vs 242.1 +/- 47.4, p < 0.05）。LATG组与OTG组在出血量、术后住院时间和镇痛药注射次数方面存在显著差异。LATG组术后早期并发症发生率显著低于OTG组（11.1% vs. 16.3%, p < 0.05）。两组手术死亡率均为零。在61.2个月（6-84个月）的中位随访期间，LATG组和OTG组的5年总生存率分别为49.3%和46.5%；两组间差异无统计学意义（p = 0.756）。我们的研究结果表明，与传统的OTG相比，LATG对晚期胃癌患者在技术上是可行的，并且可以产生良好的短期和长期肿瘤预后。
An increasing number of studies comparing laparoscopy-assisted distal gastrectomy and conventional open distal gastrectomy have been reported; the technical feasibility and clinical efficacy have been confirmed. However, few data are available to compare laparoscopy-assisted total gastrectomy (LATG) and open techniques for the treatment of advanced gastric cancer (AGC). The aim of this study is to compare the oncologic efficacy and long-term outcomes of LATG vs. open total gastrectomy (OTG) for AGC and to provide our experiences regarding these surgical difficulties as well.Using data from a clinical database of all operations performed in our department by a special surgical team, we retrospectively analysed data from 117 cases of LATG and matched OTG performed between January 2004 and December 2010. This analysis was a case-control study in which patients in the two groups were matched according to tumour location, age, gender, BMI and TNM stage via a propensity score matching method. Patient clinical characteristics, lymph node retrieval, early postoperative complications, recurrence and long-term outcomes were compared.The demographics, preoperative data and characteristics of the tumour were similar in both groups. No significant differences were found in the LATG group compared with the OTG group with regard to the number of retrieved lymph nodes or distance from the proximal margin. Operating time was longer in the LATG group than in the OTG group (292.8 +/- 49.5 vs. 242.1 +/- 47.4, p < 0.05). Significant differences were found between LATG and OTG with regard to blood loss, postoperative hospitalisation and times of analgesic injection. The early postoperative complication rates in the LATG group were significantly lower than in the OTG group (11.1 vs. 16.3 %, p < 0.05). Operative mortality was zero in both groups. During a median follow-up of 61.2 (range, 6-84) months, the overall 5-year survival rates in the LATG group and OTG group were 49.3 and 46.5 %, respectively; there was no significant difference between the two groups (p = 0.756).Our results suggest that LATG is technically feasible for advanced gastric cancer patients and can yield good short- and long-term oncologic outcomes as compared with conventional OTG.