Department of General Surgery, Chinese People's Liberation Army General Hospital, 28 Fuxing Road, Haidian District, Beijing, 100853, China.
Surg Endosc. 2018 Mar;32(3):1422-1433. doi: 10.1007/s00464-017-5826-0. Epub 2017 Oct 26.
As minimally invasive techniques advances, minimally invasive surgery (MIS) has emerged as an alternative modality for advanced gastric cancer. In this study, we compared the short- and long-term surgical outcomes of MIS and conventional open surgery for gastric cancer liver metastasis (GCLM) in terms of safety, feasibility, and efficacy.
This retrospective study used data from a prospective database at the Chinese People's Liberation Army General Hospital. From January 2006 to June 2016, 53 gastric cancer patients with synchronous liver metastasis accepted radical gastrectomy combined with either or both hepatectomy and radiofrequency ablation for liver metastases. The 53 patients enrolled in the study were divided into two groups: a conventional open surgery group (n = 42) and an MIS group (n = 11). Propensity score matching (PSM) analysis was performed to overcome possible bias.
With PSM performed at a 1:3 ratio, 11 patients who received MIS were compared with 33 open surgery cases. Mean operation time was significantly longer for the MIS group compared with the open surgery group (301 vs. 236 min, P = 0.032), while the open surgery group had a larger estimated blood loss than the MIS group (421 vs. 196 ml, P = 0.019). Time to first flatus and postoperative complications, including Clavien-Dindo classification, were similar in the two groups. However, patients undergoing MIS had a significantly shorter time to first sips of water (P = 0.020) and soft diet (P = 0.020) compared with open surgery counterparts. Long-term outcomes were comparable between groups (P = 0.090) after adjustment by PSM analysis.
MIS achieved superior short-term outcomes and comparable long-term outcomes compared with open surgery in GCLM patients. For experienced surgeons, both laparoscopic and robotic methods of MIS are reasonable approaches for the management of highly selected GCLM patients.
随着微创技术的进步，微创外科（MIS）已成为治疗进展期胃癌的一种替代方法。本研究比较了微创和传统开腹手术治疗胃癌肝转移（GCLM）的短期和长期手术结果，从安全性、可行性和疗效方面进行评估。
本回顾性研究使用了解放军总医院前瞻性数据库的数据。2006 年 1 月至 2016 年 6 月，53 例胃腺癌合并同步肝转移患者接受了根治性胃切除术联合或不联合肝切除术和射频消融术治疗肝转移灶。将 53 例患者分为两组：传统开腹手术组（n=42）和微创组（n=11）。采用倾向性评分匹配（PSM）分析克服可能的偏倚。
PSM 按 1:3 比例进行匹配后，11 例接受 MIS 的患者与 33 例开腹手术患者进行比较。MIS 组的手术时间明显长于开腹手术组（301 分钟 vs. 236 分钟，P=0.032），而开腹手术组的估计出血量大于 MIS 组（421 毫升 vs. 196 毫升，P=0.019）。两组首次肛门排气时间和术后并发症（包括 Clavien-Dindo 分级）相似。然而，与开腹手术组相比，MIS 组首次饮水和软食的时间明显缩短（P=0.020 和 P=0.020）。经 PSM 分析校正后，两组的长期结果相当（P=0.090）。
对于经验丰富的外科医生来说，腹腔镜和机器人微创手术方法都是治疗高度选择的 GCLM 患者的合理方法。与开腹手术相比，MIS 可获得更好的短期疗效，且长期结果相当。
