Ko Chang Seok, Jheong Jin Ho, Lee In-Seob, Kim Beom Su, Kim Min-Ju, Yoo Moon-Won
Department of Stomach Surgery, Asan Medical Center, University of Ulsan College of Medicine, Asan Medical Center, Seoul, Korea.
Department of Clinical Epidemiology and Biostatistics, Asan Medical Center, University of Ulsan College of Medicine, Seoul, Korea.
J Gastric Cancer. 2021 Mar;21(1):63-73. doi: 10.5230/jgc.2021.21.e7. Epub 2021 Mar 25.
This study aimed to compare the surgical outcomes of total laparoscopic total gastrectomy without mesentery division (LTG without MD) and conventional total laparoscopic total gastrectomy (CLTG), as well as evaluate the appropriate method for esophagojejunostomy (EJ) reconstruction after total laparoscopic total gastrectomy (TLTG).
We retrospectively analyzed data from 301 consecutive patients who underwent TLTG for upper or middle third gastric cancer between January 2016 and May 2019. After propensity score matching, 95 patients who underwent LTG without MD and 95 who underwent CLTG were assessed. Data on clinical characteristics and surgical outcomes, including operation time, length of postoperative hospital stay, pathological findings, and postoperative complications were analyzed.
The LTG without MD group showed a shorter time to first flatus (3.26±0.80 vs. 3.62±0.81 days, P=0.003) and a shorter time to soft diet (2.80±2.09 vs. 3.52±2.20 days, P=0.002). The total EJ-related complications in the LTG without MD group were comparable to those in the CLTG group (9.47% vs. 3.16%, P=0.083). EJ-related leakage (6.32% vs. 3.16%, P=0.317) and EJ-related stricture (3.16% vs. 1.05%, P=0.317) rates were not significantly different between the LTG without MD and CLTG groups. No significant differences were found between the two groups in terms of other early surgical outcomes such as early complications, late complications, hospital stay, and readmission rate.
LTG without MD is a safe surgical treatment for upper or middle third gastric cancer. LTG without MD may be an alternative procedure for EJ anastomosis during TLTG.
本研究旨在比较完全腹腔镜下不进行系膜离断的全胃切除术（LTG without MD）与传统完全腹腔镜下全胃切除术（CLTG）的手术效果，并评估完全腹腔镜下全胃切除术（TLTG）后食管空肠吻合术（EJ）重建的合适方法。
我们回顾性分析了2016年1月至2019年5月期间连续301例行TLTG治疗上三分之一或中三分之一胃癌患者的数据。经过倾向评分匹配后，对95例行LTG without MD的患者和95例行CLTG的患者进行评估。分析了临床特征和手术效果数据，包括手术时间、术后住院时间、病理结果和术后并发症。
LTG without MD组首次排气时间较短（3.26±0.80天 vs. 3.62±0.81天，P = 0.003），开始软食时间较短（2.80±2.09天 vs. 3.52±2.20天，P = 0.002）。LTG without MD组与EJ相关的总并发症与CLTG组相当（9.47% vs. 3.16%，P = 0.083）。LTG without MD组与CLTG组之间EJ相关的渗漏率（6.32% vs. 3.16%，P = 0.317）和EJ相关的狭窄率（3.16% vs. 1.05%，P = 0.317）无显著差异。两组在其他早期手术效果方面，如早期并发症、晚期并发症、住院时间和再入院率，均未发现显著差异。
LTG without MD是治疗上三分之一或中三分之一胃癌的一种安全手术方式。LTG without MD可能是TLTG期间EJ吻合的一种替代方法。
