Akiyama Yuji, Sasaki Akira, Iwaya Takeshi, Fujisawa Ryosuke, Sasaki Noriyuki, Nikai Haruka, Endo Fumitaka, Baba Shigeaki, Hasegawa Yasushi, Kimura Toshimoto, Takahara Takeshi, Nitta Hiroyuki, Otsuka Koki, Koeda Keisuke
Department of Surgery, Iwate Medical University School of Medicine, 2-1-1 Idaidori, Yahaba-cho, Shiwa-gun, Iwate, 028-3695, Japan.
Department of Medical Safety Science, Iwate Medical University School of Medicine, Iwate, Japan.
World J Surg Oncol. 2020 Jul 16;18(1):170. doi: 10.1186/s12957-020-01955-z.
Pylorus-preserving gastrectomy (PPG) has been accepted as a function-preserving surgery for the treatment of early gastric cancer in East Asian countries. Therefore, this study aimed to evaluate the feasibility and safety of totally laparoscopic PPG (TLPPG) with intracorporeal anastomosis.
A total of 43 patients with early gastric cancer underwent laparoscopy-assisted PPG (LAPPG) with extracorporeal anastomosis between May 2006 and November 2012. The operative outcomes of 22 patients who underwent TLPPG between November 2012 and February 2019 were evaluated, and data were compared with that of the LAPPG group.
No significant difference in the operative time was observed between the two groups. Blood loss was lower in the TLPPG group (18.5 mL) than in the LAPPG group (30.7 mL, p = 0.008), and the length of abdominal incision was shorter in the TLPPG group (3.8 cm) than in the LAPPG group (4.7 cm, p < 0.001). No significant difference in the complication rate was observed between the two groups (13.6% in the TLPPG vs. 9.3% in the LAPPG group, p = 0.594). No anastomosis-related complications occurred in either group. No significant between-group difference was observed in the delayed gastric emptying (TLPPG, 9.1 vs. LAPPG, 7%, p = 0.762). The initiation of postoperative fluid (TLPPG, 1.0 day vs. LAPPG, 3.0 days, p < 0.001) and meal (TLPPG, 3.0 days vs. LAPPG, 4.0 days, p < 0.001) intake was earlier in the TLPPG group than in the LAPPG group. No significant between-group difference was observed in the postoperative hospital stay.
The findings of this study suggest that TLPPG with intracorporeal reconstruction not only is as feasible and safe as LAPPG for the treatment of patients with early gastric cancer but also provides certain advantages such as reduced blood loss and wound size.
在东亚国家，保留幽门的胃切除术（PPG）已被公认为是一种保留功能的早期胃癌治疗手术。因此，本研究旨在评估完全腹腔镜PPG（TLPPG）联合体内吻合术的可行性和安全性。
2006年5月至2012年11月，共有43例早期胃癌患者接受了腹腔镜辅助PPG（LAPPG）及体外吻合术。评估了2012年11月至2019年2月期间接受TLPPG的22例患者的手术结果，并将数据与LAPPG组进行比较。
两组手术时间无显著差异。TLPPG组的失血量（18.5 mL）低于LAPPG组（30.7 mL，p = 0.008），TLPPG组的腹部切口长度（3.8 cm）短于LAPPG组（4.7 cm，p < 0.001）。两组并发症发生率无显著差异（TLPPG组为13.6%，LAPPG组为9.3%，p = 0.594）。两组均未发生吻合相关并发症。两组在胃排空延迟方面无显著差异（TLPPG组为9.1%，LAPPG组为7%，p = 0.762）。TLPPG组术后开始补液（TLPPG组为1.0天，LAPPG组为3.0天，p < 0.001）和进食（TLPPG组为3.0天，LAPPG组为4.0天，p < 0.001）的时间早于LAPPG组。两组术后住院时间无显著差异。
本研究结果表明，TLPPG联合体内重建术治疗早期胃癌患者不仅与LAPPG一样可行和安全，而且还具有减少失血量和伤口大小等优势。
