Kunisaki Chikara, Makino Hirochika, Yamaguchi Naotaka, Izumisawa Yusuke, Miyamato Hiroshi, Sato Kei, Hayashi Tsutomu, Sugano Nobuhiro, Suzuki Yoshihiro, Ota Mitsuyoshi, Tsuburaya Akira, Kimura Jun, Takagawa Ryo, Kosaka Takashi, Ono Hidetaka Andrew, Akiyama Hirotoshi, Endo Itaru
Department of Surgery, Gastroenterological Center, Yokohama City University, Chikara Kunisaki, 4-57 Urafune-cho, Minami-ku, Yokohama, 232-0024, Japan.
Department of Gastroenterological Surgery, Yokohama City University, Yokohama, Japan.
Surg Endosc. 2016 Dec;30(12):5520-5528. doi: 10.1007/s00464-016-4916-8. Epub 2016 May 20.
Although a few studies have reported the use of reduced-port laparoscopic gastrectomy (RPG) in gastric cancer patients, the feasibility of routinely using this technique remains unclear. It is therefore important to evaluate the surgical advantages of this technique in this patient group.
Between August 2010 and July 2015, 165 patients underwent RPGs at our hospital, performed by a single surgeon. Of these patients, 88 underwent reduced-port laparoscopic distal gastrectomy (RPLDG) and 77 underwent reduced-port laparoscopic total gastrectomy (RPLTG). In addition to short-term surgical outcomes after RPG, survival times and the surgical learning curve were also evaluated.
Blood losses during lymph node dissection in the RPLDG and RPLTG groups were not significantly different (p = 0.160). Conversion to open surgery was necessary in only two patients. Postoperative morbidities were observed in 14.8 % of the RPLDG group and 14.3 % of the RPLTG group, but there were no deaths. Most patients expressed high cosmetic satisfaction in both groups. In the RPLDG group, operation time during reconstruction decreased over the first 50 cases and then plateaued, as the surgeon's experience of the technique increased. In contrast, in the RPLTG group, operation times dropped with surgical experience for both lymph node dissection, plateauing after 40 cases, and for reconstruction, plateauing after 30 cases. Only three patients died of gastric cancer in the follow-up period and three patients died of other diseases. Five-year overall survival and 5-year disease-specific survival were 95.6 and 98.0 %, respectively.
We have shown that reduced-port gastrectomy (RPG) could be an acceptable and satisfactory procedure for treating gastric cancer for an experienced laparoscopic gastric surgeon who has sufficient previous experience of conventional laparoscopic gastrectomies.
尽管有一些研究报道了在胃癌患者中使用减孔腹腔镜胃切除术（RPG），但常规使用该技术的可行性仍不明确。因此，评估该技术在这组患者中的手术优势很重要。
2010年8月至2015年7月期间，我院165例患者接受了由一名外科医生实施的RPG手术。其中，88例行减孔腹腔镜远端胃切除术（RPLDG），77例行减孔腹腔镜全胃切除术（RPLTG）。除了RPG术后的短期手术结果外，还评估了生存时间和手术学习曲线。
RPLDG组和RPLTG组淋巴结清扫术中的失血量无显著差异（p = 0.160）。仅2例患者需要转为开放手术。RPLDG组术后发病率为14.8%，RPLTG组为14.3%，但均无死亡病例。两组大多数患者对美容效果都非常满意。在RPLDG组中，随着外科医生对该技术经验的增加，重建手术时间在前50例中逐渐减少，然后趋于平稳。相比之下，在RPLTG组中，淋巴结清扫手术时间和重建手术时间均随着手术经验的增加而下降，淋巴结清扫手术时间在40例后趋于平稳，重建手术时间在30例后趋于平稳。随访期间仅3例患者死于胃癌，3例患者死于其他疾病。5年总生存率和5年疾病特异性生存率分别为95.6%和98.0%。
我们已经表明，对于有足够传统腹腔镜胃切除术经验的经验丰富的腹腔镜胃外科医生来说，减孔胃切除术（RPG）可能是一种可接受且令人满意的治疗胃癌的手术方法。
