Total and subtotal laparoscopic gastrectomy for adenocarcinoma
Total and subtotal laparoscopic gastrectomy for adenocarcinoma
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DOI：
10.1007/s00464-005-0409-x
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发表时间：
2007-01-01
影响因子：
3.1
通讯作者：
de Martini, P.
中科院分区：
文献类型：
--
作者：
Pugliese, R.;Maggioni, D.;de Martini, P.
背景：腹腔镜胃切除术目前在许多中心进行，但是否符合肿瘤学要求仍然是一个有争议的话题。本研究的目的是比较胃腺癌腹腔镜手术和开放手术后的短期和肿瘤学结果。方法：自2000年6月至2005年6月，我院147例腺癌患者行开放或微创入路胃切除术。腹腔镜组48例，早期胃癌（EGC） 29例，中晚期胃癌（AGC） 19例。将短期结果和肿瘤学数据与99例接受开放手术的患者进行比较。分析腹腔镜组患者的生存情况。结果：腹腔镜组无术中并发症发生，仅有1例晚期大肿瘤患者行转化术。总的来说，通过D2清扫收集32个淋巴结，30个为EGC， 34个为晚期肿瘤。切除切缘6.7 cm（范围4 ~ 8 cm）。平均手术时间240 min（范围150 ~ 360 min），平均出血量150 ml（范围70 ~ 250 ml）。发病包括2例十二指肠渗漏，无再次手术愈合；在封闭或加固订书钉线后，没有发现进一步的泄漏。有一位肝硬化患者因大出血而死亡。下床和口服喂养开始明显早于开放手术。平均住院时间为10天（范围7 ~ 24天），明显短于开放手术后的18天（p < 0.05）。所有经腹腔镜治疗的患者在研究结束时均存活，无复发。结论：本研究中腹腔镜胃切除术的短期效果优于开放手术。肿瘤的根治性是一个主要的问题，但在作者的经验中，淋巴结切除术的程度与开放手术相同。本研究提示腹腔镜胃切除术在恶性肿瘤中是一种可靠的工具，肿瘤的要求可以得到保证。
Background: Laparoscopic gastrectomies are currently performed in many centers, but compliance with oncologic requirements still represents a subject open to debate. The aim of this work was to compare the short-term and oncologic outcomes after laparoscopic and open surgery in gastric adenocarcinoma.Methods: From June 2000 through June 2005, 147 patients in our institution underwent gastrectomy by open or mininvasive approach for adenocarcinoma. The laparoscopy group included 48 patients, 29 with early gastric cancer (EGC) and 19 with antral advanced gastric cancer (AGC). The short-term results and oncologic data were compared to those obtained in 99 patients who underwent open surgery. Survival in the laparoscopy group was analyzed.Results: In the laparoscopy group no intraoperative complications were observed, and conversion was needed in only one patient with a large advanced tumor. Overall, 32 lymph nodes were collected by D2 dissection, 30 for EGC, 34 for advanced cancers. The resection margin was 6.7 cm (range: 4-8 cm). The mean operating time was 240 min (range: 150-360 min), with a blood loss of 150 ml on average (range: 70-250 ml). Morbidity included two duodenal leaks that healed without reoperation; after enclosing or reinforcing the staple line, no further leaking was noted. There was one death from massive bleeding in a cirrhotic patient. Ambulation and oral feeding started significantly earlier than in open Surgery. The mean hospital stay was 10 days (range: 7-24 days), significantly shorter than the stay of 18 days after open surgery (p < 0.05). All patients treated laparoscopically were alive without recurrence at the end of this study.Conclusions: Short-term results with laparoscopic gastrectomy were better than with open surgery in this study. Oncologic radicality was a major concern, but in the authors' experience the extent of lymphadenectomy was the same as in open surgery. This study Suggests that laparoscopic gastrectomy in malignancies is a reliable tool and oncologic requirements can be warranted.