Meng Chun-yan, Lin Jian-xian, Huang Chang-ming, Zheng Chao-hui, Li Ping, Xie Jian-wei, Wang Jia-bin
Department of Gastric Surgery, Fujian Medical University Union Hospital, Fuzhou, China.
Zhonghua Wei Chang Wai Ke Za Zhi. 2012 Feb;15(2):152-6.
To evaluate the feasibility and efficacy of laparoscopy-assisted radical gastrectomy with D2 lymph node (LN) dissection for elderly patients with gastric cancer.
From January 2007 to December 2009, 255 gastric cancer patients aged over 65 years underwent D2 LN dissection. Of these, 116 patients underwent laparoscopy-assisted radical gastrectomy (LAG group), while 139 patients underwent conventional open gastrectomy (OG group). The recovery and complication rate were compared between the two groups. Risk factors associated with postoperative complications were investigated by univariate and multivariate analyses.
Compared to the OG group, the mean blood loss and number of patients who required blood transfusion were less, and the time to first flatus, the time to resume soft diet, and postoperative hospital stay were shorter in the LAG group (all P<0.01). However, the operation time and the mean number of LN retrieval were not significantly different between the two groups (both P>0.05). The postoperative morbidity in the LAG group was 15.5% (18/116), lower than that in OG group [28.1% (39/139), P<0.05]. Logistic regression analysis revealed that there were three significant factors associated with postoperative complications such as laparoscopy-assisted gastrectomy (P<0.05), operation time (P<0.01), and preoperative comorbidity (P<0.01). Operation time (P<0.05) and preoperative comorbidity (P<0.01) were independent risk factors for complication in laparoscopy-assisted radical gastrectomy of elderly patients. The mean survival time of LAG and OG were 23.0 months and 22.5 months, respectively, and the difference was not statistically significant (P>0.05).
Laparoscopy-assisted radical gastrectomy with D2 LN dissection is oncologically compatible with open gastrectomy in elderly patients with gastric cancer less invasive. Operation time and preoperative comorbidity are independent risk factors for complication in laparoscopy-assisted radical gastrectomy of elderly patients.
评估腹腔镜辅助D2淋巴结清扫根治性胃切除术治疗老年胃癌患者的可行性及疗效。
2007年1月至2009年12月，255例65岁以上胃癌患者接受了D2淋巴结清扫术。其中，116例患者接受腹腔镜辅助根治性胃切除术（LAG组），139例患者接受传统开放胃切除术（OG组）。比较两组患者的恢复情况及并发症发生率。通过单因素和多因素分析研究与术后并发症相关的危险因素。
与OG组相比，LAG组平均失血量及需要输血的患者数量更少，首次排气时间、恢复软食时间及术后住院时间更短（均P<0.01）。然而，两组手术时间及平均淋巴结清扫数量差异无统计学意义（均P>0.05）。LAG组术后发病率为15.5%（18/116），低于OG组[28.1%（39/139），P<0.05]。Logistic回归分析显示，有三个因素与术后并发症显著相关，如腹腔镜辅助胃切除术（P<0.05）、手术时间（P<0.01）及术前合并症（P<0.01）。手术时间（P<0.05）和术前合并症（P<0.01）是老年患者腹腔镜辅助根治性胃切除术后并发症的独立危险因素。LAG组和OG组的平均生存时间分别为23.0个月和22.5个月，差异无统计学意义（P>0.05）。
腹腔镜辅助D2淋巴结清扫根治性胃切除术在老年胃癌患者中与开放胃切除术具有肿瘤学等效性且侵袭性较小。手术时间和术前合并症是老年患者腹腔镜辅助根治性胃切除术后并发症的独立危险因素。
