Laparoscopic versus open subtotal gastrectomy for adenocarcinoma of the stomach in a Western population: peri-operative and 5-year oncological outcomes
Laparoscopic versus open subtotal gastrectomy for adenocarcinoma of the stomach in a Western population: peri-operative and 5-year oncological outcomes
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DOI：
10.1007/s00464-019-07146-6
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发表时间：
2019-10-07
影响因子：
3.1
通讯作者：
Preston, Shaun R.
中科院分区：
文献类型：
--
作者：
Abbassi-Ghadi, Nima;Durakovic, Sanja;Preston, Shaun R.
本研究比较了西方人群中腹腔镜胃大部切除术（LSG）与开放式胃大部切除术（OSG）治疗胃腺癌的围手术期和长期肿瘤学结局。方法对2006年11月至2016年10月期间接受根治性胃腺癌胃切除术的连续患者进行回顾性意向治疗分析研究。采用单因素分析比较LSG和OSG的围手术期结局。采用逻辑回归和自举验证来确定预测2年总生存率的独立危险因素。结果最终分析79例患者。当比较LSG（n = 30）和OSG（n = 49）时，切除的淋巴结数量没有差异（36（IQR 24.3-44）vs. 42（IQR 28-59），p = 0.165），术中失血量减少（150 ml（IQR 100-250）vs. 553 ml（IQR 338-1075），p < 0.001）和术后出血发生率增加（3例患者vs. 0，p = 0.024）。LSG（n = 22）与OSG（n = 20）的5年总生存率分别为63.6%和50%（p = 0.372）。阳性淋巴结数量[OR 0.64（CI 0.47-0.88），p = 0.006]是2年总生存率的唯一显著独立风险因素。术前阿萨分级和手术入路不影响2年生存率。结论在西方患者中，LSG与OSG在肿瘤质量和围手术期发病率方面具有可比性。2年总生存率是通过阳性淋巴结的数量来预测的，而不是切除术所采用的手术入路。
Background This study compares the peri-operative and long-term oncological outcomes for laparoscopic subtotal gastrectomy (LSG) versus open subtotal gastrectomy (OSG) for adenocarcinoma of the stomach in a Western population. Methods A retrospective, intention-to-treat analysis study was conducted for consecutive patients undergoing gastrectomy with curative intent for adenocarcinoma of the stomach between November 2006 and October 2016. Univariate analysis was used to compare peri-operative outcomes between LSG and OSG. Logistic regression with bootstrapping validation was used to identify independent risk factors for predicting 2-year overall survival. Results The final analysis included 79 patients. When comparing LSG (n = 30) to OSG (n = 49), there was no difference in the number of resected lymph nodes (36 (IQR 24.3-44) vs. 42 (IQR 28-59), p = 0.165), a reduction in intra-operative blood loss (150 ml (IQR 100-250) vs. 553 ml (IQR 338-1075), p < 0.001) and an increase incidence of post-operative bleeding (3 patients vs. 0, p = 0.024), respectively. Five-year overall survival for LSG (n = 22) versus OSG (n = 20) was 63.6% and 50% (p = 0.372), respectively. The number of positive lymph nodes [OR 0.64 (CI 0.47-0.88), p = 0.006] was the only significant independent risk factor for 2-year overall survival. Pre-operative ASA grading and operative approach did not influence survival outcomes at 2 years. Conclusion This study suggests that LSG is comparable to OSG in Western patients with respect to oncological quality and peri-operative morbidity. Two-year overall survival is predicted by the number of positive lymph nodes and not the operative access employed for resection.