Department of Surgery, University Medical Center Utrecht, Utrecht University, Utrecht, The Netherlands.
Department of Surgery, University Medical Center Utrecht, Utrecht University, Utrecht, The Netherlands; Department of Radiation Oncology, University Medical Center Utrecht, Utrecht University, Utrecht, The Netherlands.
Eur J Surg Oncol. 2019 Mar;45(3):403-409. doi: 10.1016/j.ejso.2018.08.015. Epub 2018 Sep 1.
Minimally invasive gastrectomy has been introduced in Western populations during the last decade. As minimally invasive distal gastrectomy (MIDG) versus total gastrectomy (MITG) are procedures with a different complexity, outcomes may differ. The aim of this population-based cohort study was to evaluate the safety of MIDG and MITG.
All patients who underwent potentially curative gastrectomy for gastric adenocarcinoma were included from the Dutch Upper GI Cancer Audit (2011-2016). Propensity score matching was applied to create comparable groups of patients receiving open distal gastrectomy (ODG) versus MIDG and open total gastrectomy (OTG) versus MITG, using patient and tumor characteristics. Postoperative outcomes and short-term oncological outcomes were appraised.
Of the 1970 eligible patients, 1138 underwent distal gastrectomy and 832 underwent total gastrectomy. For distal gastrectomy, 390 ODG were matched to 288 MIDG patients. Although overall postoperative morbidity and mortality were similar, patients who underwent MIDG encountered less intra-abdominal abscesses (4% vs. 1%, p = 0.039) and wound complications (6% vs. 2%, p = 0.021). The median hospital stay was shorter after MIDGs (9 vs. 7 days, p < 0.001). For total gastrectomy, 323 OTG patients were matched to 258 MITG patients. Overall postoperative morbidity, mortality and hospital stay were similar, whereas the anastomotic leakage rate was higher after MITGs (11% vs. 17%, p = 0.030). Short-term oncological outcomes between both groups were equal for distal and total gastrectomy.
Benefits of MIG during the early introduction were demonstrated for distal gastrectomy but not for total gastrectomy. An increased anastomotic leakage rate was encountered for MITG.
微创胃切除术在过去十年中已在西方人群中引入。由于微创远端胃切除术（MIDG）与全胃切除术（MITG）的复杂性不同，因此结果可能有所不同。本项基于人群的队列研究旨在评估 MIDG 和 MITG 的安全性。
从荷兰上消化道癌症审计（2011-2016 年）中纳入所有接受胃腺癌根治性胃切除术的患者。使用患者和肿瘤特征，通过倾向评分匹配，创建接受开放远端胃切除术（ODG）与 MIDG 以及开放全胃切除术（OTG）与 MITG 的可比患者组。评估了术后结果和短期肿瘤学结果。
在 1970 名合格患者中，有 1138 名接受了远端胃切除术，832 名接受了全胃切除术。对于远端胃切除术，390 例 ODG 与 288 例 MIDG 患者相匹配。尽管总体术后发病率和死亡率相似，但接受 MIDG 的患者发生腹腔脓肿的几率较低（4％比 1％，p=0.039），并且伤口并发症较少（6％比 2％，p=0.021）。MIDG 后中位住院时间较短（9 天比 7 天，p<0.001）。对于全胃切除术，323 例 OTG 患者与 258 例 MITG 患者相匹配。总体术后发病率，死亡率和住院时间相似，而 MITG 后吻合口漏的发生率较高（11％比 17％，p=0.030）。远端和全胃切除术两组之间的短期肿瘤学结果相等。
在早期引入 MIG 时，远端胃切除术的获益得到了证明，但全胃切除术则不然。MITG 发生吻合口漏的风险增加。
