Short-term surgical outcomes of a randomized controlled trial comparing laparoscopic versus open gastrectomy with D2 lymph node dissection for advanced gastric cancer
Short-term surgical outcomes of a randomized controlled trial comparing laparoscopic versus open gastrectomy with D2 lymph node dissection for advanced gastric cancer
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DOI：
10.1007/s00464-017-5942-x
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发表时间：
2018-05-01
影响因子：
3.1
通讯作者：
Yu, Peiwu
中科院分区：
文献类型：
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作者：
Shi, Yan;Xu, Xianhui;Yu, Peiwu
腹腔镜辅助胃切除术（LAG）已被公认为早期胃癌的最佳治疗方法之一。然而，LAG联合D2淋巴结清扫术在局部进展期胃癌（AGC）患者中的应用仍存在争议，我们开展了一项前瞻性随机对照试验，比较腹腔镜和开腹胃切除术联合D2淋巴结清扫术治疗局部进展期胃癌的技术安全性和肿瘤学可行性。术后发病率和死亡率基于改良的意向治疗分析，2010年1月至2012年6月期间，共有328例术前临床分期为T2- 3 N 0 - 3 M0的胃癌患者入组本试验。排除6例未切除AGC患者，其余322例患者随机分为腹腔镜组（162例）或开放组（160例）进行根治性手术。所有患者均行D2淋巴结清扫术，其中近端胃切除术18例（5.59%），远端胃切除术196例（60.87%），全胃切除术108例（33.54%）。LAG组6例患者（3.70%）转为开放手术。LAG组的总体并发症发生率为11.72%，开放组为14.38%（P = 0.512）。本研究的短期结果表明，LAG联合D2淋巴结清扫术在有经验的中心治疗局部AGC患者是安全可行的。
Laparoscopy-assisted gastrectomy (LAG) has gained acceptance as one of the best treatments for early gastric cancer. However, the application of LAG with D2 lymph node dissection in patients with locally advanced gastric cancer (AGC) remains controversial.We launched a prospective randomized controlled trial comparing laparoscopic and open gastrectomy with D2 lymph node dissection for locally AGC to evaluate technical safety and oncologic feasibility. The postoperative morbidity and mortality rates were based on the modified intention-to-treat analysis.Between January 2010 and June 2012, a total of 328 patients with preoperative clinical stage T2-3N0-3M0 gastric cancer were enrolled in the trial. Six patients with unresected AGC were excluded, and the remaining 322 patients were randomized to the laparoscopic group (162 patients) or the open group (160 patients) for radical surgery. All patients underwent D2 lymph node dissection including 18 (5.59%) proximal gastrectomies, 196 (60.87%) distal gastrectomies, and 108 (33.54%) total gastrectomies. Six patients (3.70%) in the LAG group were converted to open procedures. The overall complication rate was 11.72% in the LAG group and 14.38% in the open group (P = 0.512). No mortality occurred in either group.The short-term results of the current study suggest that LAG with D2 lymph node dissection is a safe and feasible procedure in treating patients with locally AGC in experienced centers.