Rod X, Fuks D, Macovei R, Levard H, Ferraz J-M, Denet C, Tubbax C, Gayet B, Perniceni T
Department of digestive disease, institut mutualiste Montsouris, université Paris-Descartes, 42, boulevard Jourdan, 75014 Paris, France.
Université Paris Descartes, 15, rue de l'École-de-Médecine, 75005 Paris, France.
J Visc Surg. 2018 Apr;155(2):91-97. doi: 10.1016/j.jviscsurg.2017.07.001. Epub 2018 Mar 1.
The majority of laparoscopic gastrectomy (LG) reports arise from Asia and the benefit of this approach in western countries remains unclear. The objective of this study was to compare the postoperative outcomes between LG and open gastrectomy (OG) for gastric cancer in a western center.
Between 2005 and 2015, all consecutive patients with gastric cancer who underwent either LG or OG were enrolled. Postoperative morbimortality was evaluated according to Dindo-Clavien classification.
Over 164 patients, 60 had LG and 104 OG with a mean age of 62 and 65 years, respectively. Total gastrectomy represented 58% of LG and 54% of OG (P=0.749). Operative time was not different in the two groups (160.8 vs. 174.2min, P=0.780) so as intraoperative blood loss (111 vs. 173mL, P=0.057). The rate of severe complications (including postoperative bleeding) was significantly higher in the LG group (40% vs. 23%, P=0.012) so as reoperation rate (27% vs. 6%, P<0.001). There was no statistical difference in terms of postoperative mortality (0 vs. 3%, P=0.252) or length of hospital stay (20 vs. 16 days, P=0.116).
Laparoscopic gastrectomy for the treatment of gastric cancer in western countries appears to be feasible but with a higher rate of severe complications compared to open gastrectomy.
大多数腹腔镜胃切除术（LG）的报告来自亚洲，这种手术方式在西方国家的益处仍不明确。本研究的目的是比较西方某中心腹腔镜胃切除术（LG）和开腹胃切除术（OG）治疗胃癌的术后结局。
2005年至2015年期间，纳入所有连续接受LG或OG治疗的胃癌患者。根据Dindo-Clavien分类评估术后发病率和死亡率。
164例以上患者中，60例行LG，104例行OG，平均年龄分别为62岁和65岁。全胃切除术在LG组和OG组中分别占58%和54%（P = 0.749）。两组手术时间无差异（160.8对174.2分钟，P = 0.780），术中出血量也无差异（111对173毫升，P = 0.057）。LG组严重并发症（包括术后出血）发生率显著高于OG组（40%对23%，P = 0.012），再次手术率也显著高于OG组（27%对6%，P < 0.001）。术后死亡率（0对3%，P = 0.252）或住院时间（20对16天，P = 0.116）无统计学差异。
在西方国家，腹腔镜胃切除术治疗胃癌似乎可行，但与开腹胃切除术相比，严重并发症发生率更高。
