Chan B Y O, Yau K K W, Chan C K O
Department of Surgery, Queen Elizabeth Hospital, Jordan, Hong Kong.
Department of Management Sciences, City University of Hong Kong, Kowloon Tong, Hong Kong.
Hong Kong Med J. 2019 Feb;25(1):30-7. doi: 10.12809/hkmj177150. Epub 2019 Jan 18.
Laparoscopic gastrectomy revolutionised the management of gastric cancer, yet its oncologic equivalency and safety in treating advanced gastric cancer (especially that in smaller centres) has remained controversial because of the extensive lymphadenectomy and learning curve involved. This study aimed to compare outcomes following laparoscopic versus open gastrectomy for advanced gastric cancer at a regional institution in Hong Kong.
Fifty-four patients who underwent laparoscopic gastrectomy from January 2009 to March 2017 were compared with 167 patients who underwent open gastrectomy during the same period. All had clinical T2 to T4 lesions and underwent curative-intent surgery. The two groups were matched for age, sex, American Society of Anaesthesiologists class, tumour location, morphology, and clinical stage. The endpoints were perioperative and long-term outcomes including survival and recurrence.
All patients had advanced gastric adenocarcinoma and received D2 lymph node dissection. No between-group differences were demonstrated in overall complications, unplanned readmission or reoperation within 30 days, 30-day mortality, margin clearance, rate of adjuvant therapy, or overall survival. The laparoscopic approach was associated with less blood loss (150 vs 275 mL, P=0.018), shorter operating time (321 vs 365 min, P=0.003), shorter postoperative length of stay (9 vs 11 days, P=0.011), fewer minor complications (13% vs 40%, P<0.001), retrieval of more lymph nodes (37 vs 26, P<0.001), and less disease recurrence (9% vs 28%, P=0.005).
Laparoscopic gastrectomy offers a safe and effective therapeutic option and is superior in terms of operative morbidity and potentially superior in terms of oncological outcomes compared with open surgery for advanced, surgically resectable gastric cancer, even in a small regional surgical department.
腹腔镜胃切除术彻底改变了胃癌的治疗方式，然而，由于涉及广泛的淋巴结清扫和学习曲线，其在治疗进展期胃癌（尤其是在较小中心）方面的肿瘤学等效性和安全性一直存在争议。本研究旨在比较香港一家地区机构中腹腔镜与开放胃切除术治疗进展期胃癌后的结局。
将2009年1月至2017年3月接受腹腔镜胃切除术的54例患者与同期接受开放胃切除术的167例患者进行比较。所有患者均有临床T2至T4病变，并接受了根治性手术。两组在年龄、性别、美国麻醉医师协会分级、肿瘤位置、形态和临床分期方面进行匹配。终点指标为围手术期和长期结局，包括生存和复发。
所有患者均患有进展期胃腺癌并接受了D2淋巴结清扫。在总体并发症、30天内非计划再入院或再次手术、30天死亡率、切缘阴性、辅助治疗率或总生存方面，两组之间未显示出差异。腹腔镜手术方式与更少的失血量（150 vs 275 mL，P = 0.018）、更短的手术时间（321 vs 365分钟，P = 0.003）、更短的术后住院时间（9 vs 11天，P = 0.011）、更少的轻微并发症（13% vs 40%，P < 0.001）、更多的淋巴结获取数量（37 vs 26，P < 0.001）以及更少的疾病复发（9% vs 28%，P = 0.005）相关。
对于进展期、可手术切除的胃癌，腹腔镜胃切除术提供了一种安全有效的治疗选择，与开放手术相比，在手术并发症方面更具优势，在肿瘤学结局方面可能也更具优势，即使在一个小型地区外科科室也是如此。
