Choi Su Jung, Gong Chung Sik, Kim Byung Sik, Kim Seon Ok, Kim Hee Sung
Department of Surgery, Asan Medical Center, University of Ulsan College of Medicine, Seoul, Korea.
Department of Gastric Surgery, Asan Medical Center, University of Ulsan College of Medicine, Seoul, Korea.
J Minim Invasive Surg. 2019 Mar;22(1):29-38. doi: 10.7602/jmis.2019.22.1.29. Epub 2019 Mar 15.
This study compares the feasibility and safety of Totally Laparoscopic Total Gastrectomy (TLTG) with Open Total Gastrectomy (OTG) for Remnant Gastric Cancer (RGC) in patients who had previously undergone gastrectomy.
We retrospectively collected and analyzed the data of 139 consecutive patients who underwent OTG along with 21 patients who underwent TLTG for RGC between January 2008 and December 2016. One-to-two Propensity Score Matching (PSM) was performed to compare the age, gender, body mass index, American Society of Anesthesiologists score, clinical tumor stage, previous gastric disease, previous gastrectomy type, previous reconstruction type, history of previous upper abdominal surgery except gastrectomy, and combined major operations. A total of sixty patients (21 who underwent TLTG and 39 who underwent OTG) were matched, and surgical outcomes and survival rates were compared.
The TLTG patients were found to recover bowel movements sooner than the OTG group (OTG 3.74±0.88 vs TLTG 3.19±0.81 days, =0.02). Post-operative surgical outcomes, including pathological features, clinical courses, complications and survival rates did not differ between the two groups (>0.05).
Although TLTG was not found to have any definitive clinical advantage over OTG except for more rapid recovery of bowel movement, TLTG should be considered as safe and feasible surgical procedure as OTG for the treatment of RGC.
本研究比较完全腹腔镜全胃切除术（TLTG）与开放全胃切除术（OTG）治疗既往接受过胃切除术的残胃癌（RGC）患者的可行性和安全性。
我们回顾性收集并分析了2008年1月至2016年12月期间连续139例行OTG的患者以及21例行TLTG治疗RGC患者的数据。采用1:2倾向评分匹配（PSM）比较年龄、性别、体重指数、美国麻醉医师协会评分、临床肿瘤分期、既往胃部疾病、既往胃切除类型、既往重建类型、除胃切除术外既往上腹部手术史以及联合大手术情况。共匹配了60例患者（21例行TLTG，39例行OTG），并比较了手术结果和生存率。
发现TLTG组患者肠鸣音恢复较OTG组更快（OTG组3.74±0.88天 vs TLTG组3.19±0.81天，P = 0.02）。两组术后手术结果，包括病理特征、临床病程、并发症和生存率并无差异（P>0.05）。
尽管除了肠鸣音恢复更快外，未发现TLTG相对于OTG有任何明确的临床优势，但对于RGC的治疗，TLTG应被视为与OTG一样安全可行的手术方法。
