Huang Chang-ming, Lin Jian-xian, Zheng Chao-hui, Li Ping, Xie Jian-wei, Wang Jia-bin
Department of Surgical Oncology, Fujian Medical University Union Hospital, Fuzhou 350001, China.
Zhonghua Wai Ke Za Zhi. 2011 Mar 1;49(3):200-3.
To explore the feasibility and efficacy of laparoscopy assisted radical gastrectomy on lymph node (LN) dissection for gastric cancer and to compare it with open gastrectomy.
The clinical data of 934 patients with gastric cancer underwent radical resection from January 2007 to May 2010 were analyzed retrospectively. Among the patients, 506 cases received laparoscopy assisted gastrectomy (LAG group) and 428 cases received open gastrectomy (OG group). The number of retrieved LNs and the survival curve between the two groups was compared. Then, the relations between the number of dissected LNs and postoperative morbidity were analyzed.
For all patients, the mean number of dissected LNs was 29 ± 10, there was no significantly differences between LAG group and OG group (P < 0.05). While the number of the retrieved No.7, 8 LNs in LAG group were significantly more than those in OG group. No significant differences was found in the number of dissected LNs for the pT1-2 stages tumors between the two groups, but significantly greater number of LNs was harvested by LAG group in pT3 stage (P < 0.05). No significant differences were found in the number of dissected LNs in different gastrectomy types or extents of LN dissection between the two groups. In the first 50 cases, there were less dissected LNs in LAG group than that in OG group, while 51 cases later, there was no significantly differences in number of dissected LNS between the two groups (P > 0.05). The postoperative morbidity of LAG group and OG group was 11.1% and 20.1%, respectively (P < 0.05), but there was no significant correlations between the number of dissected LNs and postoperative morbidity in both groups.
With the improvement in surgical skills, laparoscopy-assisted radical gastrectomy with lymph node dissection is a safe and feasible procedure, and it is oncologically compatible with open gastrectomy. Suitable increment of dissected LN count would not increase the postoperative complication rate.
探讨腹腔镜辅助根治性胃癌切除术在淋巴结清扫方面的可行性和疗效，并与开腹胃癌切除术进行比较。
回顾性分析2007年1月至2010年5月期间接受根治性切除的934例胃癌患者的临床资料。其中，506例接受腹腔镜辅助胃癌切除术（LAG组），428例接受开腹胃癌切除术（OG组）。比较两组的淋巴结清扫数量及生存曲线。然后，分析淋巴结清扫数量与术后并发症之间的关系。
所有患者的平均淋巴结清扫数量为29±10，LAG组和OG组之间无显著差异（P<0.05）。然而，LAG组第7、8组淋巴结清扫数量显著多于OG组。两组pT1-2期肿瘤的淋巴结清扫数量无显著差异，但LAG组在pT3期清扫的淋巴结数量显著更多（P<0.05）。两组在不同胃癌切除类型或淋巴结清扫范围内的淋巴结清扫数量无显著差异。在前50例中，LAG组的淋巴结清扫数量少于OG组，而在随后的51例中，两组的淋巴结清扫数量无显著差异（P>0.05）。LAG组和OG组的术后并发症发生率分别为11.1%和20.1%（P<0.05），但两组中淋巴结清扫数量与术后并发症之间均无显著相关性。
随着手术技巧的提高，腹腔镜辅助根治性胃癌切除术加淋巴结清扫是一种安全可行的手术，在肿瘤学上与开腹手术相当。适当增加淋巴结清扫数量不会增加术后并发症发生率。
