Laparoscopy-Assisted Pylorus-Preserving Gastrectomy Is Better Than Laparoscopy-Assisted Distal Gastrectomy for Middle-Third Early Gastric Cancer
Laparoscopy-Assisted Pylorus-Preserving Gastrectomy Is Better Than Laparoscopy-Assisted Distal Gastrectomy for Middle-Third Early Gastric Cancer
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DOI：
10.1097/sla.0b013e318294d142
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发表时间：
2014-03-01
影响因子：
9
通讯作者：
Yang, Han-Kwang
中科院分区：
文献类型：
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作者：
Suh, Yun-Suhk;Han, Dong-Seok;Yang, Han-Kwang
目的：比较腹腔镜下保幽门胃切除术（LAPPG）与腹腔镜下远端胃切除术（LADG）治疗中三分之一早期胃癌（EGC）的手术、肿瘤安全性及营养、功能效益。背景：在中三分之一的EGC患者中，尽管LAPPG具有优势，但仍难以确定LADG和LAPPG之间哪种手术更好。方法：对中三分之一EGC行LADG和LAPPG的患者进行回顾性分析。为了评估手术和肿瘤的安全性，我们分析了临床病理差异，包括术后发病率、淋巴结转移模式和复发。比较术后蛋白、白蛋白、腹部ct定量腹部脂肪面积、术后胆结石发生率，评价功能优势。结果：LADG （n = 176）和LAPPG （n = 116）的术后总发病率相似。LADG患者胃排空延迟的发生率低于LAPPG患者（1.7% vs 7.8%）；然而，LADG组所有其他并发症的发生率明显高于LAPPG组（17.0% vs 7.8%）。LADG和LAPPG的3年无复发生存率相似（分别为98.8%和98.2%），各淋巴结站检查淋巴结和转移淋巴结的数量无显著差异。术后1 ~ 6个月血清蛋白、白蛋白及术后1年腹部脂肪面积下降，LADG组明显大于LAPPG组。LADG组的3年累积胆结石发生率明显高于LAPPG组（6.5% vs 0.0%）。结论：对于中三分之一的EGC， LAPPG在营养优势和胆结石发生率方面优于LADG。
Objective: The purpose of this study is to compare the surgical, oncologic safety and the nutritional, functional benefit of laparoscopy-assisted pylorus-preserving gastrectomy (LAPPG) with laparoscopy-assisted distal gastrectomy (LADG) for middle-third early gastric cancers (EGC).Background: Of those patients with middle-third EGC, it is still difficult to determine which procedure is better between LADG and LAPPG despite alleged advantages of LAPPG.Methods: For middle-third EGC, a retrospective analysis was performed comparing those who underwent LADG and those who underwent LAPPG. To evaluate surgical and oncologic safety, clinicopathologic differences including the postoperative morbidity, the pattern of lymph node metastasis and recurrence were analyzed. Postoperative protein, albumin, quantification of abdominal fat area using abdomen computed tomography, and the incidence of postoperative gallstone were compared for the evaluation of functional advantages.Results: The overall postoperative morbidity rate was similar between LADG (n = 176) and LAPPG (n = 116). Delayed gastric emptying was less frequent in LADG than in LAPPG (1.7% vs 7.8%); however, the rates of all the other complications were significantly higher in LADG than in LAPPG (17.0% vs 7.8%). The number of examined lymph nodes and metastatic lymph nodes at each lymph node station was not significantly different and 3-year recurrence-free survival rates were also similar between LADG and LAPPG (98.8% vs 98.2%). Decreases in serum protein and albumin in postoperative 1 to 6 months and abdominal fat area in postoperative 1 year were significantly greater in LADG than in LAPPG. The 3-year cumulative incidence of gallstone was significantly higher in LADG than in LAPPG (6.5% vs 0.0%).Conclusions: For middle-third EGC, LAPPG can be considered as a better treatment option than LADG in terms of nutritional advantage and lower incidence of gallstone.