Wu Hui, Xu Ping-ping, He Yu-long, Xu Jian-bo, Cai Shi-rong, Zhang Xin-hua, Wang Liang, Yang Dong-jie, Zhan Wen-hua
Department of Gastrointestinal Diseases, First Affiliated Hospital, Sun Yat-sen University, Guangzhou 510080, China.
Zhonghua Yi Xue Za Zhi. 2012 Oct 16;92(38):2694-8.
To evaluate the impact of surgical modality for gastric cancer on operational trauma.
A total of 1499 cases of gastric cancer undergoing surgical procedures were divided into the groups of radical resection (RR, n = 1344) and palliative resection group (NRR, n = 155) according to their surgical modalities. And they were further divided into sub-groups according to the profiles of gastrectomy, extent of lymphadenectomy and multi organic resection. The extent of operational trauma (as evaluated by operative duration, transfusion volume, postoperative hospital day and incidence of complications) was compared in different groups and subgroups.
In RR and NRR groups, median transfusion volume (Q(1), Q(3)) was 0 (0, 600) vs 400 (0, 800) ml respectively. There was significant difference (P < 0.05). No significant difference existed in operative duration, postoperative hospital day or incidence of complications between two groups (all P > 0.05). In cases of distal gastrectomy, median transfusion volume was 0 (0, 400) vs 400 (200, 800) ml in RR and NRR groups (P < 0.05). No significant difference existed in operative duration, postoperative hospital day or incidence of complications between two groups (all P > 0.05). In cases of total gastrectomy, no significant difference existed in operative duration, postoperative hospital day, median transfusion volume or incidence of complications between two groups (all P > 0.05). In RR group, for the cases treated by D1, D2, D3 and paraaortic lymph node dissection (PAND), there were significant differences in operative duration ((248 ± 71), (271 ± 72), (309 ± 96), (351 ± 103) min), postoperative hospital day ((13 ± 4), (16 ± 12), (18 ± 11), (20 ± 19) days), median transfusion volume (0(0, 500), 0(0, 600), 400(0, 800), 600(200, 1000) ml) (all P < 0.05). But no significant difference existed in incidence of complications (P > 0.05). In RR group, operative duration, postoperative hospital day, median transfusion volume was (315 ± 96) vs (264 ± 66) min, (19 ± 15) vs (15 ± 11) days, 400 (0, 800) vs 0 (0, 400) ml in the patients with and without combined organic resection (all P < 0.05). But no significant difference existed in incidence of complications (P > 0.05).
As compared with palliative resection, radical resection will not increase surgical trauma. For the cases of radical resection, extent of lymphadenectomy and organic resection increase surgical trauma.
评估胃癌手术方式对手术创伤的影响。
1499例行手术治疗的胃癌患者，根据手术方式分为根治性切除组（RR，n = 1344）和姑息性切除组（NRR，n = 155）。再根据胃切除术类型、淋巴结清扫范围和多器官切除情况进一步分组。比较不同组和亚组的手术创伤程度（通过手术时长、输血量、术后住院天数和并发症发生率评估）。
RR组和NRR组的中位输血量（Q(1)，Q(3)）分别为0（0，600）ml和400（0，800）ml，差异有统计学意义（P < 0.05）。两组间手术时长、术后住院天数或并发症发生率无显著差异（均P > 0.05）。在远端胃切除病例中，RR组和NRR组的中位输血量分别为0（0，400）ml和400（200，800）ml（P < 0.05）。两组间手术时长、术后住院天数或并发症发生率无显著差异（均P > 0.05）。在全胃切除病例中，两组间手术时长、术后住院天数、中位输血量或并发症发生率无显著差异（均P > 0.05）。在RR组中，行D1、D2、D3和主动脉旁淋巴结清扫（PAND）的病例，手术时长（(248 ± 71)、(271 ± 72)、(309 ± 96)、(351 ± 103)分钟）、术后住院天数（(13 ± 4)、(16 ± 12)、(18 ± 11)、(20 ± 19)天）、中位输血量（0(0, 500)、0(0, 600)、400(0, 800)、600(200, 1000)ml）均有显著差异（均P < 0.05）。但并发症发生率无显著差异（P > 0.05）。在RR组中，有和无联合器官切除的患者，手术时长、术后住院天数、中位输血量分别为(315 ± 96) vs (264 ± 66)分钟、(19 ± 15) vs (15 ± 11)天、400(0, 800) vs 0(0, 400)ml（均P < 0.05）。但并发症发生率无显著差异（P > 0.05）。
与姑息性切除相比，根治性切除不会增加手术创伤。对于根治性切除的病例，淋巴结清扫范围和器官切除会增加手术创伤。
