*Department of Surgery, Department of Radiology †Department of Pathology ‡Cancer Research Institute §Seoul National University College of Medicine, Seoul, Korea; and ¶Department of Surgery, Seoul National University College of Medicine, Seoul National University Bundang Hospital, Gyeonggi-do, Seongnam-si, Korea.
Ann Surg. 2014 Mar;259(3):485-93. doi: 10.1097/SLA.0b013e318294d142.
The purpose of this study is to compare the surgical, oncologic safety and the nutritional, functional benefit of laparoscopy-assisted pylorus-preserving gastrectomy (LAPPG) with laparoscopy-assisted distal gastrectomy (LADG) for middle-third early gastric cancers (EGC).
Of those patients with middle-third EGC, it is still difficult to determine which procedure is better between LADG and LAPPG despite alleged advantages of LAPPG.
For middle-third EGC, a retrospective analysis was performed comparing those who underwent LADG and those who underwent LAPPG. To evaluate surgical and oncologic safety, clinicopathologic differences including the postoperative morbidity, the pattern of lymph node metastasis and recurrence were analyzed. Postoperative protein, albumin, quantification of abdominal fat area using abdomen computed tomography, and the incidence of postoperative gallstone were compared for the evaluation of functional advantages.
The overall postoperative morbidity rate was similar between LADG (n = 176) and LAPPG (n = 116). Delayed gastric emptying was less frequent in LADG than in LAPPG (1.7% vs 7.8%); however, the rates of all the other complications were significantly higher in LADG than in LAPPG (17.0% vs 7.8%). The number of examined lymph nodes and metastatic lymph nodes at each lymph node station was not significantly different and 3-year recurrence-free survival rates were also similar between LADG and LAPPG (98.8% vs 98.2%). Decreases in serum protein and albumin in postoperative 1 to 6 months and abdominal fat area in postoperative 1 year were significantly greater in LADG than in LAPPG. The 3-year cumulative incidence of gallstone was significantly higher in LADG than in LAPPG (6.5% vs 0.0%).
For middle-third EGC, LAPPG can be considered as a better treatment option than LADG in terms of nutritional advantage and lower incidence of gallstone.
本研究旨在比较腹腔镜辅助保留幽门胃切除术（LAPPG）与腹腔镜辅助远端胃切除术（LADG）治疗胃中三分之一早期胃癌（EGC）的手术、肿瘤安全性，以及营养、功能获益。
对于胃中三分之一 EGC 患者，尽管 LAPPG 具有优势，但仍难以确定 LADG 和 LAPPG 之间哪种手术方式更好。
对于胃中三分之一 EGC，对接受 LADG 和 LAPPG 的患者进行回顾性分析。为评估手术和肿瘤安全性，分析了包括术后发病率、淋巴结转移模式和复发在内的临床病理差异。通过腹部计算机断层扫描比较术后蛋白质、白蛋白、腹部脂肪面积定量以及术后胆石症的发生率，以评估功能优势。
LADG（n=176）和 LAPPG（n=116）的总体术后发病率相似。LADG 术后胃排空延迟的发生率低于 LAPPG（1.7%比 7.8%）；然而，LADG 的所有其他并发症发生率明显高于 LAPPG（17.0%比 7.8%）。每个淋巴结站检查的淋巴结和转移淋巴结数量无显著差异，LADG 和 LAPPG 的 3 年无复发生存率也相似（98.8%比 98.2%）。术后 1 至 6 个月血清蛋白和白蛋白下降以及术后 1 年腹部脂肪面积下降在 LADG 中明显大于 LAPPG。LADG 术后 3 年胆石症的累积发生率明显高于 LAPPG（6.5%比 0.0%）。
对于胃中三分之一 EGC，与 LADG 相比，LAPPG 在营养优势和较低的胆石症发生率方面可以被视为更好的治疗选择。
