Corcione Francesco, Pirozzi Felice, Cuccurullo Diego, Angelini Pierluigi, Cimmino Vincenzo, Settembre Anna
General Surgery Department, Laparoscopic and Robotic Surgery Center, Highly Specialized and of National Importance Hospital "V. Monaldi" , Naples , Italy.
Minim Invasive Ther Allied Technol. 2013 Sep;22(5):271-8. doi: 10.3109/13645706.2012.743919. Epub 2012 Nov 7.
Laparoscopic total gastrectomy (LTG) is seldom used for gastric cancer because the complex vascularization and lymphatic drainage makes lymphadenectomy and esophagojejunal anastomosis difficult and requires special skills. Our aim was to demonstrate the feasibility and accuracy of LTG in gastric cancer with D2 lymphadenectomy.
Eighty-eight LTG and four laparoscopic remnant gastrectomies (LRGs) were performed over >12 years. The median patient age was 64 years, and the male/female ratio was 1.49/1. Eighty-seven patients had a D2 and only five patients had a D1 lymphadenectomy. We propose the retrospective analysis of intra- and perioperative mortality and morbidity.
In only four of 96 cases approached by laparoscopy, a conversion to laparotomy was needed. There were two (2.17%) perioperative deaths in 92 procedures and few complications. Histological data show 79 advanced gastric cancers (AGC), 11 early gastric cancers (EGC), and two gastric diffused lymphomas. The five-year Kaplan-Meier overall survival in patients with EGC and AGC was 100% and 58%, respectively.
The results demonstrate the feasibility of an oncologically correct minimally invasive total gastrectomy. We would like to promote comparisons among different institutions to achieve better standardization of indications and techniques for a laparoscopic approach to gastric cancer.
腹腔镜全胃切除术（LTG）很少用于治疗胃癌，因为其复杂的血管分布和淋巴引流使得淋巴结清扫和食管空肠吻合术难度较大，且需要特殊技能。我们的目的是证明LTG在胃癌D2淋巴结清扫中的可行性和准确性。
在超过12年的时间里，共进行了88例LTG和4例腹腔镜残胃切除术（LRG）。患者中位年龄为64岁，男女比例为1.49∶1。87例患者接受了D2淋巴结清扫，仅5例患者接受了D1淋巴结清扫。我们对围手术期的死亡率和发病率进行回顾性分析。
在96例接受腹腔镜手术的患者中，仅4例需要中转开腹。92例手术中有2例（2.17%）围手术期死亡，并发症较少。组织学数据显示，有79例进展期胃癌（AGC）、11例早期胃癌（EGC）和2例胃弥漫性淋巴瘤。EGC和AGC患者的五年Kaplan-Meier总生存率分别为100%和58%。
结果证明了肿瘤学上正确的微创全胃切除术的可行性。我们希望促进不同机构之间的比较，以更好地规范腹腔镜胃癌手术的适应症和技术。
