Department of General Surgery, Center for Minimally Invasive Gastrointestinal Surgery, Southwest Hospital, Third Military Medical University, Chongqing, China.
Department of General Surgery, Center for Minimally Invasive Gastrointestinal Surgery, Southwest Hospital, Third Military Medical University, Chongqing, China.
Surgery. 2019 Jun;165(6):1211-1216. doi: 10.1016/j.surg.2019.01.003. Epub 2019 Feb 14.
Laparoscopy-assisted gastrectomy is a feasible and safe procedure for treating advanced gastric cancer in terms of short-term outcomes. However, concern about long-term oncologic outcomes has limited the adoption of laparoscopy-assisted gastrectomy for advanced gastric cancer.
We launched a prospective randomized controlled trial comparing laparoscopic and open gastrectomy with D2 lymph node dissection for locally advanced gastric cancer to evaluate long-term oncologic feasibility. The 5-year overall survival, disease-free survival, and tumor recurrences have been determined on an intention-to-treat basis.
Between January 2010 and June 2012, a total of 328 patients with preoperative clinical stage TNM gastric cancer were enrolled in the trial. We excluded 6 patients with unresected tumor, and the remaining 322 patients were randomized to the laparoscopic group (162 patients) or the open group (160 patients) for radical surgery. One patient in laparoscopy-assisted gastrectomy and 4 patients in open gastrectomy were lost to follow-up immediately after discharge, leaving 317 patients (161 in laparoscopy-assisted gastrectomy and 156 in open gastrectomy) eligible for long-term analysis. The 5-year overall survival rate was 49.0% in the laparoscopic group and 50.7% in the open group, and the 5-year disease-free survival rate was 47.2% and 49.6% in the 2 groups, respectively. Kaplan-Meier curves for overall survival and disease-free survival showed no differences between the 2 groups. There was no difference in the 5-year tumor recurrence rate between the 2 procedures.
Laparoscopy-assisted gastrectomy can provide comparable long-term survival without an increase in recurrence and metastasis in treating advanced gastric cancer.
腹腔镜辅助胃切除术在短期结果方面是治疗进展期胃癌的一种可行且安全的方法。然而，对长期肿瘤学结果的担忧限制了腹腔镜辅助胃切除术在治疗进展期胃癌中的应用。
我们开展了一项前瞻性随机对照试验，比较了腹腔镜和开放性胃切除术加 D2 淋巴结清扫术治疗局部进展期胃癌，以评估长期肿瘤学可行性。总生存、无病生存和肿瘤复发情况均采用意向治疗原则进行评估。
2010 年 1 月至 2012 年 6 月期间，共有 328 例术前临床分期为 TNM 胃癌患者入组该试验。我们排除了 6 例未切除肿瘤的患者，其余 322 例患者被随机分为腹腔镜组（162 例）或开放组（160 例）行根治性手术。腹腔镜辅助胃切除术中 1 例患者和开放性胃切除术中 4 例患者在出院后立即失访，共有 317 例（腹腔镜辅助胃切除术 161 例，开放性胃切除术 156 例）患者符合长期分析的条件。腹腔镜组的 5 年总生存率为 49.0%，开放组为 50.7%，两组的 5 年无病生存率分别为 47.2%和 49.6%。Kaplan-Meier 曲线显示两组的总生存和无病生存无差异。两种手术方式的 5 年肿瘤复发率无差异。
腹腔镜辅助胃切除术治疗进展期胃癌可提供相当的长期生存，而不会增加复发和转移。
