腹腔镜与开腹全胃切除术治疗胃腺癌后的短期和长期生存情况：一项全国性数据库研究
Short- and long-term survival after laparoscopic versus open total gastrectomy for gastric adenocarcinoma: a National database study.
作者信息
Gambhir Sahil, Inaba Colette S, Whealon Matthew, Sujatha-Bhaskar Sarath, Pejcinovska Marija, Nguyen Ninh T
机构信息
Department of Surgery, University of California Irvine Medical Center, 333 City Blvd West, Suite 1600, Orange, CA, 92868, USA.
Center for Statistical Consulting, University of California Irvine, Irvine, CA, 92697, USA.
出版信息
Surg Endosc. 2021 Apr;35(4):1872-1878. doi: 10.1007/s00464-020-07591-8. Epub 2020 May 11.
BACKGROUND
The use of laparoscopic total gastrectomy for gastric cancer remains controversial. Our objective was to compare outcomes of laparoscopic total gastrectomy (LTG) vs. open total gastrectomy (OTG) for gastric adenocarcinoma using a national cancer database.
METHODS
The National Cancer Database (2010-2014) was analyzed for total gastrectomy cases performed for gastric adenocarcinoma. Patient demographics and surgical outcomes were stratified by stage and compared based on laparoscopic vs. open surgical approach. Primary outcome measures included 30-day and 90-day mortality and Kaplan-Meier curves to estimate long-term survival.
RESULTS
There were 2584 cases analyzed, including 592 (22.9%) stage I, 710 (27.5%) stage II, and 1282 (49.6%) stage III cases. The distribution of LTG vs. OTG cases was 156 (26.4%) vs. 436 (73.6%) for stage I, 163 (23.0%) vs. 547 (77.0%) for stage II, and 241 (18.8%) vs. 1041 (81.2%) for stage III. For all stages analyzed, there was no difference between laparoscopic vs. open approach for adjusted 30-day mortality (stage I: adjusted odds ratio (AOR) 0.52, p = 0.75; stage II: AOR 1.36, p > 0.99; stage III: AOR 0.46, p = 0.29) or 90-day mortality (stage I: AOR 0.46, p = 0.99; stage II: AOR 1.17, p = 0.99; stage III: 0.57, p = 0.29). There was no difference between LTG vs. OTG 5-year Kaplan-Meier estimated survival curves for any stage (stage I: p = 0.20; stage II: p = 0.83; stage III: p = 0.46). When compared to OTG, LTG had a similar hazard ratio (HR) for mortality (HR 0.89 p = 0.20).
CONCLUSIONS
Laparoscopic total gastrectomy and OTG have comparable 30-day mortality, 90-day mortality, and long-term survival.
背景
腹腔镜全胃切除术在胃癌治疗中的应用仍存在争议。我们的目的是利用国家癌症数据库比较腹腔镜全胃切除术（LTG）与开放全胃切除术（OTG）治疗胃腺癌的效果。
方法
分析国家癌症数据库（2010 - 2014年）中因胃腺癌行全胃切除术的病例。根据分期对患者人口统计学和手术结果进行分层，并基于腹腔镜与开放手术方式进行比较。主要观察指标包括30天和90天死亡率以及用于估计长期生存的Kaplan-Meier曲线。
结果
共分析2584例病例，其中I期592例（22.9%），II期710例（27.5%），III期1282例（49.6%）。I期LTG与OTG病例分布分别为156例（26.4%）对436例（73.6%），II期为163例（23.0%）对547例（77.0%），III期为241例（18.8%）对1041例（81.2%）。对于所有分析阶段，腹腔镜与开放手术方式在调整后的30天死亡率（I期：调整优势比（AOR）0.52，p = 0.75；II期：AOR 1.36，p > 0.99；III期：AOR 0.46，p = 0.29）或90天死亡率（I期：AOR 0.46，p = 0.99；II期：AOR 1.17，p = 0.99；III期：0.57，p = 0.29）方面无差异。任何阶段的LTG与OTG的5年Kaplan-Meier估计生存曲线均无差异（I期：p = 0.20；II期：p = 0.83；III期：p = 0.46）。与OTG相比，LTG的死亡风险比（HR）相似（HR 0.89，p = 0.20）。
结论
腹腔镜全胃切除术和OTG在30天死亡率、90天死亡率和长期生存方面具有可比性。
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