完全腹腔镜与开腹胃癌根治术治疗早期和进展期胃癌的匹配队列研究。
Completely laparoscopic versus open gastrectomy for early and advanced gastric cancer: a matched cohort study.
机构信息
Department of Digestive Surgery, Hospital Clínico, Pontificia Universidad Católica de Chile, Marcoleta 367, P.O. Box 114-D, Santiago, 8330024, Chile.
出版信息
Surg Endosc. 2012 Mar;26(3):661-72. doi: 10.1007/s00464-011-1933-5. Epub 2011 Oct 20.
INTRODUCTION
The application of laparoscopic gastric surgery has rapidly increased for the treatment of early gastric cancer. However, laparoscopic gastrectomy for advanced tumor remains controversial, particularly in terms of oncologic outcomes. This study was designed to compare 3-year survival of laparoscopic versus open curative gastrectomy in early and advanced gastric cancer.
METHODS
This was a retrospective matched cohort study. We included patients between 2003 and 2010 with an R0 resection. A totally laparoscopic technique was used and D2 lymph node dissection was practiced routinely. We performed an intracorporeal hand-sewn esophagojejunostomy in all laparoscopic total gastrectomy cases. We matched all laparoscopic cases 1:1 with open cases according to TNM AJCC seventh edition. We used Mann-Whitney or t test and Chi-square test to compare both groups. Kaplan-Meier analysis with log-rank test was performed to compare survival.
RESULTS
We included 31 open and 31 laparoscopic cases (mean age 63 ± 14 years; 66% males). Both groups were identical in type of gastrectomy (71% total and 29% subtotal). There were no statistical difference between laparoscopic and open groups in age, sex, N category, tumor location and size, histological differentiation, and T category (48% T1, 13% T2, 16% T3, and 23% T4 in both groups), with 48% early and 52% advanced tumors. The median number of resected lymph nodes was similar: 35 (23-53) for laparoscopic and 39 (23-45) for open cases (P = 0.81). The median follow-up was 50 months. The overall 3-year survival was 82% for laparoscopic surgery and 87% for the open surgery group (P = 0.56). There were no difference in 3-year survival for the laparoscopic versus the open surgery groups for advanced tumors (74 vs. 75%, P = 0.88), N+ tumors (73 vs. 73%, P = 0.99) and for the different AJCC stages (stage 1: 94 vs. 100%, stage 2: 89 vs. 82%, and stage 3: 50 vs. 50%, P = 0.32, 0.83, and 0.98 respectively).
CONCLUSIONS
In this preliminary report, with 52% of advanced tumor, the 3-year overall and stage-by-stage survival was comparable for laparoscopic and open curative gastrectomy.
简介
腹腔镜胃手术在早期胃癌的治疗中应用迅速增加。然而，腹腔镜胃切除术治疗晚期肿瘤仍存在争议，尤其是在肿瘤学结果方面。本研究旨在比较腹腔镜与开放性根治性胃切除术治疗早期和晚期胃癌的 3 年生存率。
方法
这是一项回顾性匹配队列研究。我们纳入了 2003 年至 2010 年间接受 R0 切除的患者。使用全腹腔镜技术，常规行 D2 淋巴结清扫。所有腹腔镜全胃切除术患者均行腔内手工食管空肠吻合术。我们根据 AJCC 第 7 版 TNM 分期将所有腹腔镜病例 1:1 与开放病例匹配。我们使用 Mann-Whitney 或 t 检验和卡方检验比较两组。采用 Kaplan-Meier 分析和对数秩检验比较生存情况。
结果
我们纳入了 31 例开放手术和 31 例腹腔镜手术（平均年龄 63 ± 14 岁；男性占 66%）。两组胃切除术类型相同（71%全胃切除术和 29%胃次全切除术）。腹腔镜组和开放组在年龄、性别、N 分期、肿瘤部位和大小、组织学分化和 T 分期方面无统计学差异（两组分别有 48% T1、13% T2、16% T3 和 23% T4），其中 48%为早期肿瘤，52%为晚期肿瘤。腹腔镜组和开放组的淋巴结切除中位数相似：腹腔镜组为 35（23-53）枚，开放组为 39（23-45）枚（P = 0.81）。中位随访时间为 50 个月。腹腔镜手术的总 3 年生存率为 82%，开放手术组为 87%（P = 0.56）。在晚期肿瘤、N+肿瘤和不同 AJCC 分期中，腹腔镜手术组与开放手术组的 3 年生存率无差异（晚期肿瘤：74%比 75%，P = 0.88；N+肿瘤：73%比 73%，P = 0.99；I 期：94%比 100%，P = 0.32；II 期：89%比 82%，P = 0.83；III 期：50%比 50%，P = 0.98）。
结论
在本初步报告中，52%为晚期肿瘤，腹腔镜和开放性根治性胃切除术的 3 年总生存率和各期生存率相当。
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