Department of Gastric Surgery, Asan Medical Center, University of Ulsan College of Medicine, Seoul 05505, South Korea.
Department of Gastric Surgery, Asan Medical Center, University of Ulsan College of Medicine, Seoul 05505, South Korea
World J Gastroenterol. 2017 Dec 28;23(48):8553-8561. doi: 10.3748/wjg.v23.i48.8553.
To evaluate the safety and efficacy of totally laparoscopic total gastrectomy (TLTG) with esophagojejunostomy using a linear stapler compared with laparoscopic-assisted total gastrectomy (LATG) using a circular stapler in gastric cancer patients.
We retrospectively reviewed 687 patients who underwent laparoscopic total gastrectomy for gastric cancer at a single institution from August 2008 to August 2014. The patients were divided into two groups according to the type of operation: 421 patients underwent TLTG and 266 underwent LATG. Clinicopathologic characteristics and surgical outcomes in the two groups were compared and analyzed.
The TLTG group had higher mean ages at the time of operation (57.78 ± 11.20 years and 55.69 ± 11.96 years, = 0.020) and more histories of abdominal surgery (20.2% and 12.4%, = 0.008) compared with the LATG group. Surgical outcomes such as intraoperative and postoperative transfusions, combined operations, pain scores and administration of analgesics, and complications were similar between the two groups. However, compared with the LATG group, the TLTG group required a shorter operation time (149 min 170 min, < 0.001), had lower postoperative hematocrit change (3.49% 4.04%, = 0.002), less intraoperative events (3.1% 10.2%, < 0.001), less intraoperative anastomosis events (2.4% 7.1%, = 0.003), faster postoperative recovery such as median time to first flatus (3.30 d 3.60 d, < 0.001), faster median commencement of soft diet (4.30 d 4.60 d, < 0.001) and shorter length of postoperative hospital stay (6.75 d 7.02 d, = 0.005).
The intracorporeal method for reconstruction of esophagojejunostomy using a linear stapler may be considered a feasible procedure comparing with extracorporeal anastomosis using circular stapler because TLTG is simpler and more straightforward than LATG. Therefore, TLTG can be recommended as an appropriate procedure for gastric cancer.
评估使用直线吻合器行全腹腔镜全胃切除术（TLTG）与使用圆形吻合器行腹腔镜辅助全胃切除术（LATG）治疗胃癌的安全性和疗效。
我们回顾性分析了 2008 年 8 月至 2014 年 8 月在一家医院接受腹腔镜全胃切除术治疗的 687 例胃癌患者。根据手术方式将患者分为两组：421 例行 TLTG，266 例行 LATG。比较并分析两组患者的临床病理特征和手术结果。
TLTG 组患者的手术时年龄（57.78 ± 11.20 岁和 55.69 ± 11.96 岁， = 0.020）高于 LATG 组，且有更多的腹部手术史（20.2%和 12.4%， = 0.008）。两组患者术中及术后输血、联合手术、疼痛评分和镇痛药使用以及并发症等手术结果相似。然而，与 LATG 组相比，TLTG 组的手术时间更短（149 min 170 min， < 0.001），术后血细胞比容变化更小（3.49% 4.04%， = 0.002），术中事件更少（3.1% 10.2%， < 0.001），术中吻合口事件更少（2.4% 7.1%， = 0.003），术后恢复更快，如首次排气时间中位数（3.30 d 3.60 d， < 0.001）、开始软食时间中位数（4.30 d 4.60 d， < 0.001）和术后住院时间中位数（6.75 d 7.02 d， = 0.005）。
与使用圆形吻合器的体外吻合相比，使用直线吻合器进行腔内食管空肠重建可能是一种可行的方法，因为 TLTG 比 LATG 更简单、更直接。因此，TLTG 可作为治疗胃癌的一种合适术式。
