Short-term outcomes of D2 lymphadenectomy plus complete mesogastric excision for gastric cancer: a propensity score matching analysis
Short-term outcomes of D2 lymphadenectomy plus complete mesogastric excision for gastric cancer: a propensity score matching analysis
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D2 淋巴结切除术加胃系膜完全切除术治疗胃癌的短期结果：倾向评分匹配分析
DOI：
10.1007/s00464-022-09092-2
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发表时间：
2022-05-31
影响因子：
3.1
通讯作者：
Gong, Jianping
中科院分区：
文献类型：
--
作者：
Zhao, Dayong;Deng, Jiao;Gong, Jianping
背景我们先前的研究已经证明了D2淋巴结清扫加完全胃系膜切除（D2 + CME）在胃癌手术中的手术优势。为了进一步验证D2 + CME手术的安全性，我们进行了这次大规模的，方法回顾性分析同济医院855例腹腔镜辅助远端胃切除术（LADG）患者的临床资料，采用倾向评分匹配法（PSM）比较D2 + CME与传统D2治疗胃癌的近期疗效从前瞻性维护的临床数据库中检索了2013年12月12日至2017年12月28日期间的（传统D2队列496例，D2 + CME队列359例）。在以1：1的比例进行PSM分析后，每个队列包括219名匹配的患者。短期的结果，包括手术结果，发病率和死亡率后30天内operation.Results收集和分析在这个大规模的，观察性队列研究的基础上PSM分析，D2 + CME程序显示腹腔镜失血量少，更多的淋巴结收获，更快的术后排气比传统的D2程序。结论D2 + CME术式治疗胃癌的近期疗效优于传统D2术式。
Background Our previous study has demonstrated the surgical advantages of D2 lymphadenectomy plus complete mesogastric excision (D2 + CME) in gastric cancer surgery. To further verify the safety of D2 + CME procedure, we conducted this large-scale, observational cohort study and applied propensity score matching (PSM) approach to compare D2 + CME with conventional D2 in terms of short-term outcomes in gastric cancer patients.Methods Data on 855 patients from Tongji Hospital who underwent laparoscopic-assisted distal gastrectomy (LADG) with R0 resection (496 in the conventional D2 cohort and 359 in the D2 + CME cohort) between Dec 12, 2013 and Dec 28, 2017 were retrieved from prospectively maintained clinical database. After PSM analysis at a 1: 1 ratio, each cohort included 219-matched patients. Short-term outcomes, including surgical results, morbidity, and mortality within 30 days after the operation, were collected and analyzed.Results In this large-scale, observational cohort study based on PSM analysis, the D2 + CME procedure showed less intra-laparoscopic blood loss, more lymph node harvest, and faster postoperative flatus than the conventional D2 procedure. However, both the overall and severe postoperative adverse events (Clavien-Dindo classification grade >= III a) seemed comparable between two cohorts.Conclusion The present study showed that D2 + CME was associated with better short-term outcomes than conventional D2 dissection for patients with resectable gastric cancer.