Li Zhengyan, Liu Yezhou, Hao Yiming, Bai Bin, Yu Deliang, Zhao Qingchuan
Xijing Hospital of Digestive Diseases, The Fourth Military Medical University, Xi'an, 710032, China.
Xijing Hospital of Digestive Diseases, The Fourth Military Medical University, Xi'an, 710032, China.
Surg Oncol. 2019 Mar;28:167-173. doi: 10.1016/j.suronc.2019.01.003. Epub 2019 Jan 8.
To date, it has been unclear whether laparoscopic gastrectomy (LG) is suitable for patients with serosa-positive (pT4a) gastric cancer. The purpose of this study was to compare the surgical and long-term oncologic outcomes of LG and open gastrectomy for pT4a gastric cancer.
We prospectively collected data from 987 patients with pathological confirmed pT4a gastric cancer who underwent LG or OG at our institution between June 2009 and May 2015. A 1:1 matched propensity score matching (PSM) analysis was performed to reduce confounding bias. The primary outcome was 5-year overall survival (OS).
After PSM, a well-balanced cohort of 202 pairs patients was analyzed. The LG group showed a longer operation time (261.42 vs. 171.00 min, P = 0.001), less blood loss (185.47 vs. 217.84 ml, P = 0.000), and shorter postoperative hospital stay (7.56 vs. 8.22 days, P = 0.007). The overall complication rate was 14.4% in the LG group and 16.3% in the OG group (P = 0.581). The minor (grade II) and severe (grade ≥ IIIa) complication rates were similar (LG, 6.9% vs. OG, 9.9%, P = 0.282; LG, 7.4% vs. OG, 6.4%, P = 0.695, respectively). The LG and OG groups showed similar survival 5-year OS and 5-year Disease-free survival (DFS) rates (44.6% vs. 42.1%, P = 0.403; 40.1 vs. 37.6%, P = 0.321, respectively). The recurrence rate and pattern did not differ between the two groups during the follow-up stage (P > 0.05).
For patients with pT4a gastric cancer, LG with D2 lymph node dissection can be a safe and feasible procedure in terms of surgical and long-term oncologic outcomes.
迄今为止，腹腔镜胃切除术（LG）是否适用于浆膜阳性（pT4a）胃癌患者尚不清楚。本研究的目的是比较LG和开腹胃切除术治疗pT4a胃癌的手术及长期肿瘤学结局。
我们前瞻性收集了2009年6月至2015年5月期间在本机构接受LG或开腹胃切除术（OG）的987例病理确诊为pT4a胃癌患者的数据。进行1:1匹配的倾向评分匹配（PSM）分析以减少混杂偏倚。主要结局为5年总生存率（OS）。
PSM后，分析了一组均衡的202对患者。LG组手术时间更长（261.42对171.00分钟，P = 0.001），失血量更少（185.47对217.84毫升，P = 0.000），术后住院时间更短（7.56对8.22天，P = 0.007）。LG组总体并发症发生率为14.4%，OG组为16.3%（P = 0.581）。轻度（II级）和重度（≥IIIa级）并发症发生率相似（LG组6.9%对OG组9.9%，P = 0.282；LG组7.4%对OG组6.4%，P = 0.695）。LG组和OG组5年OS率和5年无病生存率（DFS）相似（分别为44.6%对42.1%，P = 0.403；40.1对37.6%，P = 0.321）。随访期间两组复发率及复发模式无差异（P>0.05）。
对于pT4a胃癌患者，行D2淋巴结清扫的LG在手术及长期肿瘤学结局方面是一种安全可行的手术方式。
