腹腔镜辅助胃癌根治术与开腹胃癌根治术的手术效果比较：一项病例对照研究。
Surgical outcomes of laparoscopy-assisted gastrectomy versus open gastrectomy for gastric cancer: a case-control study.
机构信息
Department of Surgery, Gastroenterological Center, Yokohama City University, 4-57, Urafune-cho, Minami-ku, Yokohama, 232-0024, Japan.
出版信息
Surg Endosc. 2012 Mar;26(3):804-10. doi: 10.1007/s00464-011-1956-y. Epub 2011 Oct 15.
BACKGROUND
The aim of this study was to clarify the technical feasibility and oncological efficacy of laparoscopy-assisted gastrectomy (LAG) for gastric cancer compared with open gastrectomy (OG).
METHODS
Between April 2002 and March 2008, a series of 623 patients with gastric cancer underwent R0 gastrectomy (314 LAG patients and 309 OG patients). Age, gender, lymph node dissection, and pathological stage were matched by propensity scoring, and 212 patients (106 LAG and 106 OG) were selected for analysis after the exclusion of 40 patients who had proximal gastrectomy. Intraoperative factors, postoperative morbidity, long-term quality of life (QOL), and survival were evaluated. Moreover, these outcomes were also compared between the laparoscopy-assisted total gastrectomy (LATG) and the open total gastrectomy (OTG).
RESULTS
There was no significant difference in preoperative characteristics between the two patient groups. Regarding intraoperative characteristics, blood loss was significantly lower in the LAG group (143 ml) than in the OG group (288 ml), while operation time was significantly longer in the LAG group (273 min) than the OG group (231 min). The degree of lymph node dissection and number of retrieved lymph nodes did not differ between the two groups. There were no significant differences in postoperative courses or overall and disease-specific survival (89.8% vs. 83.6%, P = 0.0886; 100% vs. 95.2%, P = 0.1073) except time to first flatus and time to use of nonsteroidal anti-inflammatory derivatives between the two groups. Significantly fewer patients felt wound pain in the LAG group 1 year after surgery. Analyses between the LATG and OTG groups showed similar results.
CONCLUSIONS
LAG for gastric cancer may be both feasible and safe. However, it will be necessary to conduct a well-designed randomized controlled trial comparing short-term and long-term outcomes between LAG and OG in a larger number of patients.
背景
本研究旨在阐明与开腹胃癌根治术（OG）相比，腹腔镜辅助胃癌根治术（LAG）的技术可行性和肿瘤学疗效。
方法
2002 年 4 月至 2008 年 3 月，623 例胃癌患者接受了 R0 胃切除术（314 例 LAG 患者和 309 例 OG 患者）。通过倾向评分匹配年龄、性别、淋巴结清扫和病理分期，排除 40 例近端胃切除术后，选择 212 例患者（106 例 LAG 和 106 例 OG）进行分析。评估了术中因素、术后发病率、长期生活质量（QOL）和生存情况。此外，还比较了腹腔镜辅助全胃切除术（LATG）和开腹全胃切除术（OTG）之间的这些结果。
结果
两组患者的术前特征无显著差异。关于术中特征，LAG 组（143ml）的出血量明显低于 OG 组（288ml），而 LAG 组的手术时间明显长于 OG 组（273min 对 231min）。两组淋巴结清扫程度和淋巴结检出数量无显著差异。两组患者术后病程或总生存期和疾病特异性生存期无显著差异（89.8%对 83.6%，P=0.0886；100%对 95.2%，P=0.1073），但两组患者首次排气时间和非甾体抗炎药使用时间除外。术后 1 年，LAG 组患者伤口疼痛明显少于 LAG 组。LATG 组与 OTG 组的分析结果相似。
结论
腹腔镜辅助胃癌根治术是可行和安全的。然而，有必要在更多患者中进行设计良好的随机对照试验，比较 LAG 和 OG 的短期和长期结果。
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