Department of Surgery, Jikei University School of Medicine, Tokyo, Japan.
Dig Surg. 2010;27(5):343-6. doi: 10.1159/000318774. Epub 2010 Sep 14.
The utility and problems including the socioeconomic aspect of laparoscopy-assisted distal gastrectomy for gastric cancer have not been fully evaluated.
We compared open distal gastrectomy and laparoscopy-assisted distal gastrectomy for the clinical benefit, quality of life, and problems of operation cost by the reference documents in which the difference between open distal gastrectomy and laparoscopy-assisted distal gastrectomy was examined in detail. The reference documents retrieved by the key words 'gastric, cancer, laparoscopic, surgery' were 22 in PubMed with the following limits activated: Humans, Clinical Trial, Meta-Analysis, Randomized Controlled Trial, Review, English, Core clinical journals, published in the last 10 years.
The operation time of laparoscopy-assisted distal gastrectomy is longer than that of open distal gastrectomy. However, if skilled, the blood loss of laparoscopy-assisted distal gastrectomy is less, the hospitalization days and the duration of fasting after laparoscopy-assisted distal gastrectomy are shorter than those after open distal gastrectomy. The number of excised lymph nodes and the incidence of postoperative complications were similar between laparoscopy-assisted distal gastrectomy and open distal gastrectomy. On the other hand, in the national health insurance system, the operation fee of open distal gastrectomy was USD 6,637 as compared to USD 7,586 for laparoscopy-assisted distal gastrectomy. In spite of the USD 949 difference in the operation fee, the use of disposable instruments for laparoscopy-assisted distal gastrectomy results in a deficit of USD 1,500 over open distal gastrectomy.
In spite of the medical superiority of laparoscopy-assisted distal gastrectomy over open distal gastrectomy (if a skilled surgeon operates) as less invasive surgery, laparoscopy-assisted distal gastrectomy is associated with less financial benefit to the hospital as compared to open distal gastrectomy in the current Japanese health insurance system.
腹腔镜辅助远端胃切除术治疗胃癌的实用性和问题（包括社会经济学方面）尚未得到充分评估。
我们通过详细检查开腹远端胃切除术和腹腔镜辅助远端胃切除术差异的参考文献，比较了开腹远端胃切除术和腹腔镜辅助远端胃切除术的临床获益、生活质量和手术成本问题。通过关键词“gastric, cancer, laparoscopic, surgery”在 PubMed 中检索到 22 篇参考文献，激活了以下限制条件：人类、临床试验、荟萃分析、随机对照试验、综述、英语、核心临床期刊、在过去 10 年中发表。
腹腔镜辅助远端胃切除术的手术时间长于开腹远端胃切除术。然而，如果技术熟练，腹腔镜辅助远端胃切除术的出血量较少，腹腔镜辅助远端胃切除术后的住院天数和禁食时间短于开腹远端胃切除术后。腹腔镜辅助远端胃切除术和开腹远端胃切除术的切除淋巴结数量和术后并发症发生率相似。另一方面，在国家医疗保险制度下，开腹远端胃切除术的手术费用为 6637 美元，而腹腔镜辅助远端胃切除术为 7586 美元。尽管手术费用相差 949 美元，但由于腹腔镜辅助远端胃切除术使用一次性器械，与开腹远端胃切除术相比，其亏损为 1500 美元。
尽管腹腔镜辅助远端胃切除术作为一种微创术式具有优于开腹远端胃切除术的医学优势（如果由技术熟练的外科医生操作），但在当前日本医疗保险制度下，与开腹远端胃切除术相比，腹腔镜辅助远端胃切除术对医院的经济效益较低。
