Department of Gastrointestinal Surgery, Tongji Hospital, Tongji Medical College, Huazhong University of Science and Technology, Wuhan, 430030, Hubei, China.
Department of Thyroid and Breast Surgery, People's Hospital of Henan Province, Zhengzhou, 450003, China.
Surg Endosc. 2022 Aug;36(8):5921-5929. doi: 10.1007/s00464-022-09092-2. Epub 2022 May 31.
Our previous study has demonstrated the surgical advantages of D2 lymphadenectomy plus complete mesogastric excision (D2 + CME) in gastric cancer surgery. To further verify the safety of D2 + CME procedure, we conducted this large-scale, observational cohort study and applied propensity score matching (PSM) approach to compare D2 + CME with conventional D2 in terms of short-term outcomes in gastric cancer patients.
Data on 855 patients from Tongji Hospital who underwent laparoscopic-assisted distal gastrectomy (LADG) with R0 resection (496 in the conventional D2 cohort and 359 in the D2 + CME cohort) between Dec 12, 2013 and Dec 28, 2017 were retrieved from prospectively maintained clinical database. After PSM analysis at a 1:1 ratio, each cohort included 219-matched patients. Short-term outcomes, including surgical results, morbidity, and mortality within 30 days after the operation, were collected and analyzed.
In this large-scale, observational cohort study based on PSM analysis, the D2 + CME procedure showed less intra-laparoscopic blood loss, more lymph node harvest, and faster postoperative flatus than the conventional D2 procedure. However, both the overall and severe postoperative adverse events (Clavien-Dindo classification grade ≥ III a) seemed comparable between two cohorts.
The present study showed that D2 + CME was associated with better short-term outcomes than conventional D2 dissection for patients with resectable gastric cancer.
我们之前的研究表明，在胃癌手术中，D2 淋巴结清扫术加完整中胃切除术（D2+CME）具有手术优势。为了进一步验证 D2+CME 手术的安全性，我们进行了这项大规模、观察性队列研究，并应用倾向评分匹配（PSM）方法比较了 D2+CME 与传统 D2 在胃癌患者短期结果方面的差异。
从 2013 年 12 月 12 日至 2017 年 12 月 28 日，从前瞻性维护的临床数据库中检索了在同济医院接受腹腔镜辅助远端胃切除术（LADG）和 R0 切除的 855 例患者的数据（传统 D2 队列 496 例，D2+CME 队列 359 例）。经过 1:1 比例的 PSM 分析后，每个队列包括 219 例匹配患者。收集并分析了短期结果，包括手术后 30 天内的手术结果、发病率和死亡率。
在这项基于 PSM 分析的大规模观察性队列研究中，D2+CME 手术的腹腔镜内出血量较少，淋巴结采集量较多，术后排气较快，与传统 D2 手术相比。然而，两组的总体和严重术后不良事件（Clavien-Dindo 分类等级≥IIIa）似乎相似。
本研究表明，对于可切除的胃癌患者，D2+CME 与传统 D2 解剖相比，具有更好的短期结果。
