Comparison of long-term outcomes of laparoscopy-assisted and open distal gastrectomy for early gastric cancer
Comparison of long-term outcomes of laparoscopy-assisted and open distal gastrectomy for early gastric cancer
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DOI：
10.1007/s00464-008-0198-0
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发表时间：
2009-08-01
影响因子：
3.1
通讯作者：
Han, Ho-Seong
中科院分区：
文献类型：
--
作者：
Lee, Joo-Ho;Yom, Cha-Kyong;Han, Ho-Seong
腹腔镜辅助下远端胃切除术（LADG）在早期胃癌（EGC）中的应用仍然存在争议，因为缺乏长期安全性和可行性的证据。我们评估了LADG与传统开放式远端胃切除术（ODG）治疗EGC的长期疗效。在1999年3月至2006年7月期间，106例患者接受LADG治疗，105例患者接受ODG治疗。回顾性比较两组患者的临床病理特征、术后预后、住院时间、术后发病率、术后死亡率和远期预后，包括癌症复发和生存。所有患者的中位随访时间为55个月。LADG组术后恢复明显更快；排气发生早、开始流质饮食早、术后住院时间短（p < 0.05）。LADG组平均手术时间明显延长。与ODG组相比，LADG组术后并发症发生率较低（4.7% vs 13.3%, p = 0.046）。2例（0.9%）发生肿瘤复发，1例（0.5%）发生与复发相关的死亡。所有患者的总5年生存率（5-YSR）为95.5%，疾病特异性5-YSR为98.8%。两组患者生存率无显著差异；ODG组和LADG组的总体5-YSR分别为94.9%和95.9%。我们的数据表明LADG治疗EGC是可行和安全的。我们期望本研究的结果能得到前瞻性随机分析的证实。
Application of laparoscopy-assisted distal gastrectomy (LADG) for early gastric cancer (EGC) is still controversial because of scant evidence of long-term safety and feasibility. We evaluated the long-term outcome of LADG compared with conventional open distal gastrectomy (ODG) for EGC.Between March 1999 and July 2006, 106 patients underwent LADG and 105 patients underwent ODG for EGC. Clinicopathologic characteristics, postoperative outcomes, hospital course, postoperative morbidity, postoperative mortality, and long-term outcomes, including cancer recurrence and survival, were retrospectively compared between the two groups. Survival of all patients was confirmed with 55-month median follow-up.Postoperative recovery was significantly faster in the LADG group; passing flatus occurred earlier, starting a liquid diet began sooner, and postoperative hospital stay was shorter (p < 0.05). Mean operation time was significantly longer in the LADG group. Postoperative complications in the LADG group occurred less frequently compared with in the ODG group (4.7% versus 13.3%, p = 0.046). Tumor recurrence occurred in two cases (0.9%) and death related to recurrence occurred in only one patient (0.5%). Overall 5-year survival rate (5-YSR) of all patients was 95.5%, while disease-specific 5-YSR was 98.8%. There was no significant difference in survival rates between the two groups; overall 5-YSR of the ODG and LADG groups was 94.9% and 95.9%, respectively.Our data suggest that LADG for EGC is feasible and safe. We expect the results of the present study to be confirmed by prospective randomized analysis.