Yuan Peng, Yan Yan, Jia Yongning, Wang Jing, Li Ziyu, Wu Qi
Key Laboratory of Carcinogenesis and Translational Research (Ministry of Education), Department of Endoscopy, Peking University Cancer Hospital & Institute, Beijing, China.
Key Laboratory of Carcinogenesis and Translational Research (Ministry of Education), Department of Gastrointestinal Surgery, Peking University Cancer Hospital & Institute, Beijing, China.
J Gastrointest Oncol. 2021 Feb;12(1):142-152. doi: 10.21037/jgo-20-277.
In totally laparoscopic gastrectomy (TLG), it is usually difficult to determine the proximal margin. Therefore, the present study evaluated the usefulness of intraoperative gastroscopy for direct marking of the tumor proximal margin during TLG for cancer in the upper third of the stomach.
This retrospective cohort study included 52 patients with gastric cancer who underwent TLG from January 2018 to May 2020. The proximal margin of tumors was determined by intraoperative gastroscopic methods.
Patients were divided into short (1 cm) and long (2 cm) groups according to the distance to the proximal margin of the tumor. Participants consisted of 41 males and 11 females with a median age of 63.5 years. Tumors involving the esophagogastric junction (EGJ) occurred in 27 patients. Siewert type II and III tumors were present in 42 and 10 patients, respectively. The median operative time was 244 min. The long group had a statistically significant lower frequency of positive margin than the short group (0% 17.4%, P=0.033). Total gastrectomy was performed in 35 patients, and 17 patients received proximal gastrectomy. No complications associated with the procedure occurred in any patient.
Intraoperative endoscopic views for tumor proximal localization can be used effectively during TLG for patients with upper third gastric cancer. Our results indicate that a distance of ≥2 cm from the proximal resection margin to the tumor was necessary to achieve a negative resection margin. In the future, this may be used as an alternative to frozen section diagnosis.
在完全腹腔镜胃切除术（TLG）中，通常难以确定近端切缘。因此，本研究评估了术中胃镜检查在胃上部三分之一癌症的TLG手术中直接标记肿瘤近端切缘的实用性。
这项回顾性队列研究纳入了2018年1月至2020年5月期间接受TLG手术的52例胃癌患者。通过术中胃镜检查方法确定肿瘤的近端切缘。
根据肿瘤近端切缘的距离，将患者分为短距离（1 cm）组和长距离（2 cm）组。参与者包括41名男性和11名女性，中位年龄为63.5岁。27例患者的肿瘤累及食管胃交界（EGJ）。分别有42例和10例患者为Siewert II型和III型肿瘤。中位手术时间为244分钟。长距离组的切缘阳性率在统计学上显著低于短距离组（0%对17.4%，P = 0.033）。35例患者接受了全胃切除术，17例患者接受了近端胃切除术。所有患者均未发生与手术相关的并发症。
术中内镜观察用于肿瘤近端定位在胃上部三分之一癌症患者的TLG手术中可有效应用。我们的结果表明，近端切除缘与肿瘤的距离≥2 cm对于实现切缘阴性是必要的。未来，这可作为冰冻切片诊断的替代方法。
