Tsunoda Shigeru, Okabe Hiroshi, Obama Kazutaka, Tanaka Eiji, Hisamori Shigeo, Kinjo Yousuke, Sakai Yoshiharu
Department of Surgery, Graduate School of Medicine, Kyoto University, 54 Kawahara-cho, Shogoin, Sakyo-ku, Kyoto, 606-8507, Japan,
World J Surg. 2014 Oct;38(10):2662-7. doi: 10.1007/s00268-014-2611-2.
Although laparoscopic distal gastrectomy has become a viable treatment option for gastric cancer, laparoscopic total gastrectomy remains in limited use.
The present study was designed to evaluate the short-term outcomes of totally laparoscopic total gastrectomy (TLTG).
The records of 112 consecutive patients who underwent TLTG for gastric cancer between September 2006 and November 2012 were reviewed, and surgical outcomes were retrospectively investigated.
Neoadjuvant chemotherapy was given to 21 patients (18.8 %). The degree of lymphadenectomy was D1+ in 83 patients (74.1 %) and D2 in 29 (25.9 %). The operation time was 359 min, median intraoperative blood loss was 85 ml, and median total number of harvested lymph nodes was 64. Grade II or higher postoperative complications developed in 25 patients (22.3 %). On univariate analysis, pathologic stages IB to IV (versus stage IA) overlapped esophagojejunostomy (versus functional end-to-end esophagojejunostomy) and operation time >360 min (versus ≤360 min) were related to postoperative morbidity. In the multivariate analysis, operative time and pathologic stage were independent risk factors for postoperative complications.
TLTG is feasible and can be performed with acceptable postoperative morbidity. A longer operating time and more advanced pathologic stage were significantly associated with higher postoperative morbidity.
尽管腹腔镜远端胃癌切除术已成为治疗胃癌的一种可行选择，但腹腔镜全胃切除术的应用仍然有限。
本研究旨在评估完全腹腔镜全胃切除术（TLTG）的短期疗效。
回顾性分析2006年9月至2012年11月期间连续112例行TLTG治疗胃癌患者的病历，并对手术结果进行回顾性研究。
21例患者（18.8%）接受了新辅助化疗。83例患者（74.1%）的淋巴结清扫程度为D1+，29例（25.9%）为D2。手术时间为359分钟，术中中位失血量为85毫升，中位清扫淋巴结总数为64枚。25例患者（22.3%）发生Ⅱ级或更高等级的术后并发症。单因素分析显示，病理分期为IB至IV期（与IA期相比）、采用食管空肠吻合术（与功能性端端食管空肠吻合术相比）以及手术时间>360分钟（与≤360分钟相比）与术后发病率相关。多因素分析显示，手术时间和病理分期是术后并发症的独立危险因素。
TLTG是可行的，术后发病率可接受。较长的手术时间和更晚的病理分期与更高的术后发病率显著相关。
