Marchesi Federico, De Sario Giuseppina, Cecchini Stefano, Tartamella Francesca, Riccò Matteo, Romboli Andrea
Dipartimento di Medicina e Chirurgia, sezione di Clinica Chirurgica Generale, Università degli studi di Parma, Via Gramsci n.14, 43100 Parma Italia..
Acta Biomed. 2017 Oct 23;88(3):302-309. doi: 10.23750/abm.v88i3.6541.
In the last decades, after some initial concern, laparoscopic subtotal gastrectomy (LSG) is gaining popularity also for the treatment of advanced gastric cancer (AGC). The aim of this study is to compare a single surgeon initial experience on LSG and open subtotal gastrectomy in terms of surgical safety and radicality, postoperative recovery and midterm oncological outcomes.
a case control study was conducted matching the first 13 LSG for AGC with 13 open procedures performed by the same surgeon. Operative and pathological data, postoperative parameters and midterm oncological outcomes were analyzed.
There was no significant difference in mortality (0%) and morbidity, while the laparoscopic approach allowed lower analgesic consumption and faster bowel movement recovery. Operation time was significantly higher in LSG patients (301.5 vs 232 min, p: 0.023), with an evident learning curve effect. Both groups had a high rate of adequate lymph node harvest, but the number was significantly higher in LSG group (p: 0.033). No significant difference in survival was registered. Multivariate analysis identified age at diagnosis, diffuse-type tumor, pN and LODDS as independent predictors of worse prognosis.
LSG can be safely performed for the treatment of AGC, allowing faster postoperative recovery.
在过去几十年里，经过最初的一些关注后，腹腔镜胃次全切除术（LSG）在治疗进展期胃癌（AGC）方面也越来越受欢迎。本研究的目的是比较同一外科医生在LSG和开腹胃次全切除术方面的初始经验，包括手术安全性和根治性、术后恢复情况以及中期肿瘤学结果。
进行了一项病例对照研究，将前13例AGC的LSG病例与同一外科医生进行的13例开腹手术进行匹配。分析了手术和病理数据、术后参数以及中期肿瘤学结果。
死亡率（0%）和发病率无显著差异，而腹腔镜手术方法可减少镇痛药物用量并加快肠道功能恢复。LSG患者的手术时间显著更长（301.5分钟对232分钟，p：0.023），存在明显的学习曲线效应。两组的淋巴结清扫充分率都很高，但LSG组的清扫数量显著更多（p：0.033）。生存率无显著差异。多因素分析确定诊断时年龄、弥漫型肿瘤、pN和LODDS为预后较差的独立预测因素。
LSG可安全用于治疗AGC，能使术后恢复更快。
