Hao Yingxue, Yu Peiwu, Qian Feng, Zhao Yongliang, Shi Yan, Tang Bo, Zeng Dongzhu, Zhang Chao
Department of General Surgery, Center for Minimally Invasive Gastrointestinal Surgery, Southwest Hospital, Third Military Medical University, Chongqing, China.
Medicine (Baltimore). 2016 Jun;95(25):e3936. doi: 10.1097/MD.0000000000003936.
Laparoscopy-assisted gastrectomy (LAG) has gained international acceptance for the treatment of early gastric cancer (EGC). However, the use of laparoscopic surgery in the management of advanced gastric cancer (AGC) has not attained widespread acceptance. This retrospective large-scale patient study in a single center for minimally invasive surgery assessed the feasibility and safety of LAG for T2 and T3 stage AGC. A total of 628 patients underwent LAG and 579 patients underwent open gastrectomy (OG) from Jan 2004 to Dec 2011. All cases underwent radical lymph node (LN) dissection from D1 to D2+. This study compared short- and long-term results between the 2 groups after stratifying by pTNM stages, including the mean operation time, volume of blood loss, number of harvested LNs, average days of postoperative hospital stay, mean gastrointestinal function recovery time, intra- and post-operative complications, recurrence rate, recurrence site, and 5-year survival curve. Thirty-five patients (5.57%) converted to open procedures in the LAG group. There were no significant differences in retrieved LN number (30.4 ± 13.4 vs 28.1 ± 17.2, P = 0.43), proximal resection margin (PRM) (6.15 ± 1.63 vs 6.09 ± 1.91, P = 0.56), or distal resection margin (DRM) (5.46 ± 1.74 vs 5.40 ± 1.95, P = 0.57) between the LAG and OG groups, respectively. The mean volume of blood loss (154.5 ± 102.6 vs 311.2 ± 118.9 mL, P < 0.001), mean postoperative hospital stay (7.6 ± 2.5 vs 10.7 ± 3.6 days, P < 0.001), mean time for gastrointestinal function recovery (3.3 ± 1.4 vs 3.9 ± 1.5 days, P < 0.001), and postoperative complications rate (6.4% vs 10.5%, P = 0.01) were clearly lower in the LAG group compared to the OG group. However, the recurrence pattern and site were not different between the 2 groups, even they were stratified by the TNM stage. The 5-year overall survival (OS) rates were 85.38%, 79.70%, 57.81%, 34.60% and 88.31%, 75.49%, 56.84%, 33.08% in patients with stage Ib, IIa, IIb, and IIIa, respectively, in the LAG and OG groups. There were no statistically significant differences in the OS rate for patients with the same TNM stage between the 2 groups. LAG with radical LN dissection is a safe and technically feasible procedure for the treatment of AGC staged below T3.
腹腔镜辅助胃癌切除术（LAG）在早期胃癌（EGC）治疗方面已获得国际认可。然而，腹腔镜手术在进展期胃癌（AGC）治疗中的应用尚未得到广泛接受。这项在单一微创手术中心开展的回顾性大规模患者研究评估了LAG治疗T2和T3期AGC的可行性和安全性。2004年1月至2011年12月期间，共有628例患者接受了LAG，579例患者接受了开腹胃癌切除术（OG）。所有病例均接受了从D1到D2+的根治性淋巴结清扫。本研究比较了两组按pTNM分期分层后的短期和长期结果，包括平均手术时间、失血量、收获的淋巴结数量、术后平均住院天数、平均胃肠功能恢复时间、术中和术后并发症、复发率、复发部位以及5年生存曲线。LAG组中有35例患者（5.57%）中转开腹手术。LAG组和OG组之间在收获的淋巴结数量（30.4±13.4对28.1±17.2，P = 0.43）、近端切缘（PRM）（6.15±1.63对6.09±1.91，P = 0.56）或远端切缘（DRM）（5.46±1.74对5.40±1.95，P = 0.57）方面分别无显著差异。与OG组相比，LAG组的平均失血量（154.5±102.6对311.2±118.9 mL，P < 0.001）、术后平均住院天数（7.6±2.5对10.7±3.6天，P < 0.001）、平均胃肠功能恢复时间（3.3±1.4对3.9±1.5天，P < 0.001）以及术后并发症发生率（6.4%对10.5%，P = 0.01）明显更低。然而，两组之间的复发模式和部位并无差异，即使按TNM分期进行分层也是如此。LAG组和OG组中Ib期、IIa期、IIb期和IIIa期患者的5年总生存率（OS）分别为85.38%、79.70%、57.81%、34.60%和88.31%、75.49%、56.84%、33.08%。两组中相同TNM分期患者的OS率无统计学显著差异。对于T3期以下的AGC，行根治性淋巴结清扫的LAG是一种安全且技术上可行的手术。
