Department of Surgery, Kitasato University School of Medicine, 2-1-1 Asamizodai, Sagamihara, Kanagawa 228-8520, Japan.
Surg Endosc. 2013 May;27(5):1695-705. doi: 10.1007/s00464-012-2658-9. Epub 2012 Dec 18.
Short-term outcomes of laparoscopy-assisted distal gastrectomy (LADG) and open DG (ODG) have been investigated in previous clinical trials, but operative techniques and concomitant treatments have evolved, and up-to-date evidence produced by expert surgeons is required to provide an accurate image of the relative efficacies of the treatments. The purpose of this study was to compare laparoscopic versus ODG with respect to specific primary and secondary short-term outcomes.
From October 2005 to February 2008, a total of 64 patients with early gastric cancer were randomly assigned to the LADG or the ODG group. One patient was excluded due to concurrent illness unrelated to the intervention, so the data from 63 patients were analyzed. The primary short-term outcome was the 4-day postoperative use of analgesics. Secondary short-term outcomes were postoperative residual pain, complications, days hospitalized, blood data, days with fever, and days to first flatus.
There was a significant difference in favor of LADG for postoperative use of analgesics (P = 0.022). Unexpectedly, there was no significant difference in degree of pain in the immediate postoperative period, putatively due to the optimal use of analgesics. Of the secondary outcomes, residual pain at postoperative day 7 (P = 0.003) and days to first flatus (P = 0.001) were significantly better with LADG. Postoperative complications, number of days hospitalized, and number of days with fever were also better with LADG, but the differences were not significant. Blood data representing inflammation (WBC and CRP) showed marked differences, especially on postoperative day 7 (P = 0.0016 and P = 0.0061, respectively).
LADG performed by expert surgeons results in less postoperative pain accompanied by decreased surgical invasiveness and is associated with fewer postoperative inconveniences. No preliminary suggestions of changes in long-term curability were observed. LADG for early gastric cancer is a feasible and safe procedure with short-term clinical results superior to those of ODG.
腹腔镜辅助远端胃切除术（LADG）和开放式胃切除术（ODG）的短期疗效已在先前的临床试验中进行了研究，但手术技术和伴随治疗已经发展，需要由专家外科医生提供的最新证据来准确评估两种治疗方法的相对疗效。本研究旨在比较腹腔镜与 ODG 在特定的主要和次要短期结果方面的差异。
从 2005 年 10 月至 2008 年 2 月，共有 64 例早期胃癌患者被随机分配至 LADG 或 ODG 组。由于与干预无关的合并症，1 例患者被排除，因此对 63 例患者的数据进行了分析。主要短期结果是术后 4 天使用镇痛药。次要短期结果是术后残留疼痛、并发症、住院天数、血液数据、发热天数和首次排气天数。
LADG 在术后使用镇痛药方面有显著优势（P = 0.022）。出乎意料的是，在术后即刻疼痛程度方面没有显著差异，这可能是由于镇痛药的最佳使用。在次要结果中，术后第 7 天的残留疼痛（P = 0.003）和首次排气时间（P = 0.001）均显著改善。LADG 术后并发症、住院天数和发热天数也有所改善，但差异无统计学意义。代表炎症的血液数据（白细胞和 C 反应蛋白）差异明显，尤其是在术后第 7 天（P = 0.0016 和 P = 0.0061）。
由专家外科医生进行的 LADG 术后疼痛较轻，手术侵袭性较小，术后不便较少。未观察到长期治愈能力发生变化的初步迹象。对于早期胃癌，LADG 是一种可行且安全的手术，具有优于 ODG 的短期临床结果。
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