Long-Term Results of Laparoscopic Gastrectomy for Gastric Cancer: A Large-Scale Case-Control and Case-Matched Korean Multicenter Study
Long-Term Results of Laparoscopic Gastrectomy for Gastric Cancer: A Large-Scale Case-Control and Case-Matched Korean Multicenter Study
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DOI：
10.1200/jco.2013.48.8551
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发表时间：
2014-03-01
影响因子：
45.3
通讯作者：
Ryu, Seong Yeob
中科院分区：
文献类型：
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作者：
Kim, Hyung-Ho;Han, Sang-Uk;Ryu, Seong Yeob
目的腹腔镜辅助胃切除术治疗胃癌的肿瘤预后尚未得到评价。本研究的目的是回顾性地验证腹腔镜胃切除术治疗胃癌的长期生存率、发病率和死亡率的有效性和安全性。患者和方法研究组包括2976例患者，1998年4月至2005年12月期间接受腹腔镜胃切除术（1477例）或开放式胃切除术（1499例）治疗。采用Kaplan-Meier法对病例对照和病例匹配人群进行长期5年实际生存分析。评估发病率、死亡率和学习曲线。结果在病例对照研究中，除经腹腔镜治疗的IA期癌症患者总生存率增高（腹腔镜组95.3%，开腹组90.3%,P < 0.001）外，各癌症分期的总生存率、疾病特异性生存率和无复发生存率（中位随访期70.8个月）均无统计学差异。在使用倾向评分系统进行匹配后，每个阶段的总生存率、疾病特异性生存率和无复发生存率没有统计学差异。病例匹配组开放组和腹腔镜组的发病率分别为15.1%和12.5%，差异无统计学意义（P = 0.184）。死亡率差异无统计学意义（开放组为0.3%，腹腔镜组为0.5%,P = 1.000）。平均学习曲线为42。结论在一项大规模、多中心、回顾性临床研究中，腹腔镜胃切除术治疗胃癌患者的长期肿瘤预后与开放式胃切除术相当。
Purpose The oncologic outcomes of laparoscopy-assisted gastrectomy for the treatment of gastric cancer have not been evaluated. The aim of this study is to validate the efficacy and safety of laparoscopic gastrectomy for gastric cancer in terms of long-term survival, morbidity, and mortality retrospectively.Patients and Methods The study group comprised 2,976 patients who were treated with curative intent either by laparoscopic gastrectomy (1,477 patients) or open gastrectomy (1,499 patients) between April 1998 and December 2005. The long-term 5-year actual survival analysis in case-control and case-matched population was conducted using the Kaplan-Meier method. The morbidity and mortality and learning curves were evaluated.Results In the case-control study, the overall survival, disease-specific survival, and recurrence-free survival (median follow-up period, 70.8 months) were not statistically different at each cancer stage with the exception of an increased overall survival rate for patients with stage IA cancer treated via laparoscopy (laparoscopic group; 95.3%, open group: 90.3%; P < .001). After matching using a propensity scoring system, the overall survival, disease-specific survival, and recurrence-free survival rates were not statistically different at each stage. The morbidity of the case-matched group was 15.1% in the open group and 12.5% in the laparoscopic group, which also had no statistical significance (P = .184). The mortality rate was also not statistically significant (0.3% in the open group and 0.5% in the laparoscopic group; P = 1.000). The mean learning curve was 42.Conclusion The long-term oncologic outcomes of laparoscopic gastrectomy for patients with gastric cancer were comparable to those of open gastrectomy in a large-scale, multicenter, retrospective clinical study.