Department of Surgery, Osaka Police Hospital, 10-31, Kitayama-cho, Tennoji-ku, Osaka 543-0035, Japan.
Surg Endosc. 2012 Jun;26(6):1702-9. doi: 10.1007/s00464-011-2096-0. Epub 2011 Dec 30.
Laparoscopy-assisted gastrectomy (LAG) has been established as a low-invasive surgery for early gastric cancer. However, it remains unknown whether it is applicable also for advanced gastric cancer, mainly because the long-term results of LAG with D2 lymph node dissection for advanced gastric cancer have not been well validated compared with open gastrectomy (OG).
A retrospective cohort study was performed to compare LAG and OG with D2 lymph node dissection. For this study, 167 patients (66 LAG and 101 OG patients) who underwent gastrectomy with D2 lymph node dissection for advanced gastric cancer were reviewed. Recurrence-free survival and overall survival time were estimated using Kaplan-Meier curves. Stratified log-rank statistical evaluation was used to compare the difference between the LAG and OG groups stratified by histologic type, pathologic T status, N status, and postoperative adjuvant chemotherapy. The adjusted Cox proportional hazards regression models were used to calculate the hazard ratios (HRs) of LAG.
The 5-year recurrence-free survival rate was 89.6% in the LAG group and 75.8% in the OG group (nonsignificant difference; stratified log-rank statistic, 3.11; P = 0.0777). The adjusted HR of recurrence for LAG compared with OG was 0.389 [95% confidence interval (CI) 0.131-1.151]. The 5-year overall survival rate was 94.4% in the LAG group and 78.5% in the OG group (nonsignificant difference; stratified log-rank statistic, 0.4817; P = 0.4877). The adjusted HR of death for LAG compared with OG was 0.633 (95% CI 0.172-2.325).
The findings show that LAG with D2 lymph node dissection is acceptable in terms of long-term results for advanced gastric cancer cases and may be applicable for advanced gastric cancer treatment.
腹腔镜辅助胃切除术（LAG）已被确立为早期胃癌的微创手术。然而，对于进展期胃癌，它是否适用仍不清楚，主要是因为与开腹胃切除术（OG）相比，LAG 联合 D2 淋巴结清扫术治疗进展期胃癌的长期结果尚未得到很好的验证。
本研究进行了一项回顾性队列研究，比较了 LAG 和 OG 联合 D2 淋巴结清扫术。在这项研究中，对 167 例接受 D2 淋巴结清扫术治疗进展期胃癌的患者（66 例 LAG 和 101 例 OG 患者）进行了回顾性分析。采用 Kaplan-Meier 曲线估计无复发生存和总生存时间。采用分层对数秩统计评估，比较了按组织学类型、病理 T 分期、N 分期和术后辅助化疗分层的 LAG 和 OG 组之间的差异。采用调整后的 Cox 比例风险回归模型计算 LAG 的风险比（HR）。
LAG 组的 5 年无复发生存率为 89.6%，OG 组为 75.8%（无显著差异；分层对数秩统计量为 3.11；P=0.0777）。与 OG 相比，LAG 复发的调整 HR 为 0.389（95%置信区间 [CI] 0.131-1.151）。LAG 组的 5 年总生存率为 94.4%，OG 组为 78.5%（无显著差异；分层对数秩统计量为 0.4817；P=0.4877）。与 OG 相比，LAG 死亡的调整 HR 为 0.633（95%CI 0.172-2.325）。
研究结果表明，LAG 联合 D2 淋巴结清扫术在治疗进展期胃癌方面具有可接受的长期疗效，可能适用于进展期胃癌的治疗。
