Choi Chang In, Lee Chang Min, Park Ji Ho, Jee Ye Seob, Lee Han Hong, Jeong Oh, Park Sungsoo
Department of Surgery, Biomedical Research Institute, Pusan National University College of Medicine, Busan, South Korea.
Department of Surgery, Korea University College of Medicine, Seoul, South Korea.
Front Oncol. 2019 Oct 3;9:982. doi: 10.3389/fonc.2019.00982. eCollection 2019.
To analyze the surgical trend and brief postoperative results of laparoscopic distal gastrectomy (LDG) in Korea on the basis of a multicenter cohort. Data of 812 patients who underwent LDG between January and December 2016 were collected from 14 surgeons at 7 institutions. Patients were divided into laparoscopy-assisted distal gastrectomy (LADG) group and totally laparoscopic distal gastrectomy (TLDG) group. Perioperative and clinicopathologic outcomes were compared retrospectively. Among the patients [ = 222 (27.3%) LADG; = 590 (72.7%) TLDG], there are no significant differences in patient's demographics (sex, age, body mass index, and American Society of Anesthesiologists score). Billroth-I anastomosis (84.7%) was most performed in the LADG group, but Billroth-II anastomosis (59.0%) in the TLDG group ( < 0.001). The mean operative time was longer in the TLDG group (197.3 ± 44.4 min vs. 222.0 ± 60.2 min, < 0.001), and there was no statistical difference in the hospital stay between the two groups (9.6 ± 4.8 days vs. 8.9 ± 7.1 days, = 0.149). There were no significant differences in morbidity and mortality between the two groups. The length of proximal margin was longer in the TLDG group (4.3 ± 3.1 cm vs. 6.0 ± 3.4 cm, < 0.001), but the distal margin was longer in the LADG group (6.5 ± 3.7 cm vs. 5.5 ± 3.1 cm, < 0.001). The distribution of operations among each institution was shown very heterogeneously. There was no significant difference related to surgical outcome between LADG and TLDG in pre-study survey prior to KLASS-07 trial. Therefore, to obtain more reliable data, well designed prospective randomized controlled study is needed.
基于多中心队列分析韩国腹腔镜远端胃癌切除术（LDG）的手术趋势及简要术后结果。收集了2016年1月至12月间7家机构的14位外科医生实施的812例LDG患者的数据。患者被分为腹腔镜辅助远端胃癌切除术（LADG）组和全腹腔镜远端胃癌切除术（TLDG）组。对围手术期和临床病理结果进行回顾性比较。在这些患者中[LADG组222例（27.3%）；TLDG组590例（72.7%）]，患者的人口统计学特征（性别、年龄、体重指数和美国麻醉医师协会评分）无显著差异。LADG组中毕Ⅰ式吻合术（84.7%）最为常见，而TLDG组中毕Ⅱ式吻合术（59.0%）更为常见（P<0.001）。TLDG组的平均手术时间更长（197.3±44.4分钟对222.0±60.2分钟，P<0.001），两组间住院时间无统计学差异（9.6±4.8天对8.9±7.1天，P = 0.149）。两组间的发病率和死亡率无显著差异。TLDG组近端切缘长度更长（4.3±3.1厘米对6.0±3.4厘米，P<0.001），但LADG组远端切缘更长（6.5±3.7厘米对5.5±3.1厘米，P<0.001）。各机构间手术分布差异很大。在KLASS - 07试验前的预研究调查中，LADG和TLDG在手术结果方面无显著差异。因此，为获得更可靠的数据，需要设计良好的前瞻性随机对照研究。
