Laparoscopic Versus Open D2 Gastrectomy for Gastric Cancer: A Case-Matched Comparative Study
Laparoscopic Versus Open D2 Gastrectomy for Gastric Cancer: A Case-Matched Comparative Study
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DOI：
10.1089/lap.2020.0023
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发表时间：
2020-03-30
影响因子：
1.3
通讯作者：
Almasri, Mahmoud
中科院分区：
文献类型：
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作者：
Ammori, Basil J.;Asmer, Huthaifa;Almasri, Mahmoud
背景：腹腔镜D2胃切除术治疗胃癌的作用仍然存在争议。本研究的目的是比较腹腔镜与开腹切除术的手术和短期肿瘤结局。方法：回顾性分析了2017年至2019年期间接受潜在治愈性D2胃切除术的患者。患者的年龄和手术程度（全胃切除术与胃次全切除术，以及额外的器官切除术）按1：1的比例随机匹配。排除包括急诊或姑息手术。包括腹腔镜切除术的学习曲线。基于意向治疗进行分析。结果被报道为中位数（范围）或百分之酌情。结果：在78例患者进行了潜在的根治性胃切除术36匹配。两组在年龄、性别、美国麻醉医师协会（阿萨）评分、术前血清白蛋白和血红蛋白、体重指数、既往腹部手术频率、疾病解剖分布、胃切除程度、是否需要额外切除和疾病分期方面具有可比性。有1例转为开放性手术。虽然腹腔镜手术需要更长的手术时间（393对218分钟，P <0.001），但失血量更少（100对200 mL，P = 0.001），住院时间更短（3.0对7.5天，P <0.001）。有没有显着差异的临床显着的并发症，死亡率，再入院率，再手术，淋巴结检索，和R-1切除率。结论：腹腔镜下的方法，以潜在的治疗胃癌D2胃切除术与手术创伤小，恢复快，同时提供了一个等效的肿瘤切除术。
Background: The role of the laparoscopic approach to D2 gastrectomy for gastric cancer remains controversial. The aim of this study was to compare the operative and short-term oncologic outcomes of laparoscopic versus open resections.Methods: Patients who underwent potentially curative D2 gastrectomy between 2017 and 2019 were retrospectively reviewed. Patients were randomly matched on 1:1 basis for age and extent of surgery (total versus subtotal gastrectomy, and additional organ resection). Exclusions included emergency or palliative surgery. The learning curve for laparoscopic resections was included. Analysis was conducted on intention to treat basis. The outcomes were reported as median (range) or per cent as appropriate.Results: Among 78 patients who had undergone potentially curative gastrectomy 36 were matched. The groups were comparable for age, sex, American Society of Anesthesiologists (ASA) score, preoperative serum albumin and hemoglobin, body mass index, frequency of previous abdominal surgery, anatomic distribution of disease, extent of gastrectomy, need for additional resection, and disease stage. There was one conversion to open surgery. Although laparoscopic surgery required longer operating time (393 versus 218 minutes, P < .001), it was associated with less blood loss (100 versus 200 mL, P = .001) and shorter hospital stay (3.0 versus 7.5 days, P < .001). There were no significant differences in the rates of clinically significant complications, mortality, readmissions, reoperations, lymph node retrieval, and R-1 resections.Conclusions: The laparoscopic approach to potentially curative D2 gastrectomy for gastric cancer is associated with less operative trauma and quicker recovery while offering an equivalent oncologic resection.