Department of General Surgery, Center for Minimally Invasive Gastrointestinal Surgery, Southwest Hospital, Third Military Medical University, No. 30 Gao Tan Yan Road, Chongqing, 400038, China.
Surg Endosc. 2018 May;32(5):2427-2433. doi: 10.1007/s00464-017-5942-x. Epub 2017 Dec 12.
Laparoscopy-assisted gastrectomy (LAG) has gained acceptance as one of the best treatments for early gastric cancer. However, the application of LAG with D2 lymph node dissection in patients with locally advanced gastric cancer (AGC) remains controversial.
We launched a prospective randomized controlled trial comparing laparoscopic and open gastrectomy with D2 lymph node dissection for locally AGC to evaluate technical safety and oncologic feasibility. The postoperative morbidity and mortality rates were based on the modified intention-to-treat analysis.
Between January 2010 and June 2012, a total of 328 patients with preoperative clinical stage TNM gastric cancer were enrolled in the trial. Six patients with unresected AGC were excluded, and the remaining 322 patients were randomized to the laparoscopic group (162 patients) or the open group (160 patients) for radical surgery. All patients underwent D2 lymph node dissection including 18 (5.59%) proximal gastrectomies, 196 (60.87%) distal gastrectomies, and 108 (33.54%) total gastrectomies. Six patients (3.70%) in the LAG group were converted to open procedures. The overall complication rate was 11.72% in the LAG group and 14.38% in the open group (P = 0.512). No mortality occurred in either group.
The short-term results of the current study suggest that LAG with D2 lymph node dissection is a safe and feasible procedure in treating patients with locally AGC in experienced centers.
腹腔镜辅助胃切除术（LAG）已被公认为治疗早期胃癌的最佳方法之一。然而，对于局部进展期胃癌（AGC）患者，LAG 联合 D2 淋巴结清扫的应用仍存在争议。
我们开展了一项前瞻性随机对照试验，比较腹腔镜和开腹胃切除术联合 D2 淋巴结清扫术治疗局部 AGC，以评估技术安全性和肿瘤学可行性。术后发病率和死亡率基于意向治疗分析。
2010 年 1 月至 2012 年 6 月，共有 328 例术前临床分期为 TNM 胃癌患者入组本试验。有 6 例未切除的 AGC 患者被排除，其余 322 例患者被随机分为腹腔镜组（162 例）或开腹组（160 例）行根治性手术。所有患者均行 D2 淋巴结清扫术，其中 18 例行近端胃切除术（5.59%），196 例行远端胃切除术（60.87%），108 例行全胃切除术（33.54%）。腹腔镜组中有 6 例（3.70%）患者转为开腹手术。腹腔镜组的总并发症发生率为 11.72%，开腹组为 14.38%（P=0.512）。两组均无死亡病例。
本研究的短期结果表明，在经验丰富的中心，LAG 联合 D2 淋巴结清扫术治疗局部 AGC 是一种安全可行的方法。
