Laparoscopic subtotal gastrectomy for advanced gastric cancer: technical aspects and surgical, nutritional and oncological outcomes
Laparoscopic subtotal gastrectomy for advanced gastric cancer: technical aspects and surgical, nutritional and oncological outcomes
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DOI：
10.1007/s00464-017-5526-9
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发表时间：
2017-11-01
影响因子：
3.1
通讯作者：
Uyama, Ichiro
中科院分区：
文献类型：
--
作者：
Nakauchi, Masaya;Suda, Koichi;Uyama, Ichiro
背景全胃切除术的发病率高于远端胃切除术，但腹腔镜胃次全切除术（LsTG）已被报道是安全可行的早期胃癌（GC）。我们确定了LsTG治疗进展期胃癌（AGC）的手术、营养和肿瘤学结局。方法在2008年至2012年期间在我们机构接受根治性胃切除术的816例连续GC患者中，253例接受根治性腹腔镜胃切除术（LG）治疗AGC。LsTG适用于希望避免全胃切除术、距食管胃交界处< 4 cm、近端切缘2 cm且冷冻切片中切割端阴性的胃上第三部分肿瘤患者，而腹腔镜常规远端胃切除术（LcDG）和腹腔镜全胃切除术（LTG）则不适用。结果253例患者中，Clavien-Dindo分级≥ III级者43例（17.0%）。3年总生存率和3年无复发生存率分别为80.2%和73.5%。分别在121、27和105例患者中进行了LcDG、LsTG和LTG。发病率与LTG密切相关（P = 0.001）。LTG组术后体重减轻明显大于LcDG或LsTG组（P < 0.001）。LcDG组与LsTG组术后并发症发生率和体重减轻率无显著差异。结论LG治疗AGC是安全可行的。从手术和术后营养的角度来看，LsTG治疗AGC可能比LTG更安全。
Background Higher morbidity in total gastrectomy than in distal gastrectomy has been reported, but laparoscopic subtotal gastrectomy (LsTG) has been reported to be safe and feasible in early gastric cancer (GC). We determined the surgical, nutritional and oncological outcomes of LsTG for advanced gastric cancer (AGC).Methods Of the 816 consecutive patients with GC who underwent radical gastrectomy at our institution between 2008 and 2012, 253 who underwent curative laparoscopic gastrectomy (LG) for AGC were enrolled. LsTG was indicated for patients with upper stomach third tumors, who hoped to avoid total gastrectomy, < 4 cm to the esophagogastric junction and a 2-cm proximal margin with cut end negative in frozen section, whereas laparoscopic conventional distal gastrectomy (LcDG) and laparoscopic total gastrectomy (LTG) were performed otherwise. Surgical outcomes and postoperative nutritional status were primarily assessed.Results Of 253 patients, the morbidity (Clavien-Dindo classification grade >= III) was 17.0% (43 patients). The 3-year overall survival and 3-year recurrence-free survival rates were 80.2 and 73.5%, respectively. LcDG, LsTG and LTG were performed in 121, 27 and 105 patients, individually. Morbidity was strongly associated with LTG (P = 0.001). Postoperative loss of body weight was significantly greater after LTG in comparison with LcDG or LsTG (P < 0.001). No difference in morbidity and postoperative loss of body weight were observed between LcDG and LsTG group.Conclusions LG for AGC was feasible and safe surgically and oncologically. LsTG for AGC may be safer than LTG from surgical and postoperative nutritional point of view.