Kiyama Teruo, Fujita Itsuo, Kanno Hitoshi, Tani Aya, Yoshiyuki Toshiro, Kato Shunji, Tajiri Takashi, Barbul Adrian
Department of Surgery, Nippon Medical School, 1-1-5 Sendagi, Bunkyo-ku, Tokyo, 113-8603, Japan.
J Gastrointest Surg. 2008 Oct;12(10):1807-11. doi: 10.1007/s11605-008-0599-3. Epub 2008 Aug 6.
The purpose of this study was to evaluate the safety and value of laparoscopy-assisted distal gastrectomy (LADG) for early stage gastric cancer (stages IA, IB, and II).
We retrospectively assessed 101 cases treated by LADG and compared to 49 contemporaneous cases treated by open distal gastrectomy (DG) between 2001 and 2006. Clinical variables, such as tumor diameter, operation time, blood loss, number of lymph nodes dissected, and length of stay were investigated.
Tumor size (mm) was significantly smaller in the LADG group (p < 0.0001). Although operation time (min) in the two groups was similar (278 +/- 57 vs. 268 +/- 55), mean blood loss was significantly higher in the DG group (139 +/- 181 vs. 460 +/- 301, p < 0.0001). Fewer lymph nodes were harvested in the LADG group (27 +/- 14 vs. 34 +/- 19, p = 0.012). Hospital stay was longer in the DG group (13.3 +/- 8.5 vs. 16.7 +/- 10.5, p = 0.034). There was no mortality in either group. Postoperative surgical complications occurred in six (6%) of the LADG and four (8%) of the DG.
The authors conclude that laparoscopy-assisted distal gastrectomy is a safe and useful operation for early-stage gastric cancers. If patients are selected properly, laparoscopy-assisted distal gastrectomy can be a curative and minimally invasive treatment for gastric cancer.
本研究旨在评估腹腔镜辅助远端胃癌切除术(LADG)治疗早期胃癌(IA期、IB期和II期)的安全性和价值。
我们回顾性评估了2001年至2006年间接受LADG治疗的101例患者,并与同期接受开放远端胃癌切除术(DG)的49例患者进行比较。研究了临床变量,如肿瘤直径、手术时间、失血量、清扫淋巴结数量和住院时间。
LADG组的肿瘤大小(mm)明显更小(p < 0.0001)。尽管两组的手术时间(分钟)相似(278 ± 57 vs. 268 ± 55),但DG组的平均失血量明显更高(139 ± 181 vs. 460 ± 301,p < 0.0001)。LADG组清扫的淋巴结较少(27 ± 14 vs. 34 ± 19,p = 0.012)。DG组的住院时间更长(13.3 ± 8.5 vs. 16.7 ± 10.5,p = 0.034)。两组均无死亡病例。LADG组有6例(6%)发生术后手术并发症,DG组有4例(8%)发生。
作者得出结论,腹腔镜辅助远端胃癌切除术是治疗早期胃癌的一种安全有效的手术。如果患者选择得当,腹腔镜辅助远端胃癌切除术可以成为一种治愈性的微创胃癌治疗方法。