Department of Faculty Surgery №2, I.M.Sechenov First Moscow State Medical University, Moscow, Russia.
The Intervention Centre, Oslo University Hospital, Oslo, Norway.
World J Surg Oncol. 2022 Jun 25;20(1):216. doi: 10.1186/s12957-022-02674-3.
Laparoscopic surgery has justified its efficacy in the treatment of early gastric cancer. There are limited data indicating the eligibility of laparoscopic interventions in locally advanced gastric cancer. Publications describing the safety of laparoscopic techniques in the treatment of local and metastatic gastric cancer complicated by bleeding and stenosis are scarce.
The study included patients with histologically confirmed locally advanced and disseminated gastric cancer and complicated with bleeding and/or stenosis who underwent gastrectomy with vital indications between February 2012 and August 2018. Surgical and oncologic outcomes after laparoscopic surgery (laparoscopic surgery) and open surgery (OS) were compared.
In total, 127 patients (LS, n = 52; OS, n = 75) were analyzed. Baseline characteristics were similar between the groups. Forty-four total gastrectomies with resection of the abdominal part of the esophagus, 63 distal subtotal (43 Billroth-I and 20 Billroth-II), and 19 proximal gastrectomies were performed. The median duration of surgery was significantly longer in the LS group, 253 min (interquartile range [IQR], 200-295) versus 210 min (IQR, 165-220) (p < 0.001), while median intraoperative blood loss in the LS group was significantly less, 180 ml (IQR, 146-214) versus 320 ml (IQR, 290-350), (p < 0.001). Early postoperative complications occurred in 35% in the LS group and in 45 % of patients in the OS group (p = 0.227). There was no difference in postoperative mortality rates between the groups (3 [6 %] versus 5 (7 %), p = 1.00). Median intensive care unit stay and median postoperative hospital stay were significantly shorter after laparoscopy, 2 (IQR, 1-2) versus 4 (IQR, 3-4) days, and 8 (IQR, 7-9) versus 10 (IQR, 8-12) days, both p < 0.001. After laparoscopy, patients started adjuvant chemotherapy significantly earlier than those after open surgery, 20 vs. 28 days (p < 0.001). However, overall survival rates were similar between the group. Three-year overall survival was 24% in the LS group and 27% in the OS groups.
Despite the technical complexity, in patients with complicated locally advanced and metastatic gastric cancer, laparoscopic gastrectomies were associated with longer operation time, reduced intraoperative blood loss, shorter reconvalescence, and similar morbidity, mortality rates and long-term oncologic outcomes compared to conventional open surgery.
腹腔镜手术已被证明在早期胃癌的治疗中是有效的。目前仅有有限的数据表明腹腔镜干预在局部进展期胃癌中的适应证。描述腹腔镜技术在治疗伴有出血和/或狭窄的局部和转移性胃癌的安全性的出版物很少。
本研究纳入了 2012 年 2 月至 2018 年 8 月期间因有生命指征而行胃切除术的组织学确诊为局部进展期和播散性胃癌并伴有出血和/或狭窄的患者。比较了腹腔镜手术（腹腔镜手术组）和开放手术（OS 组）后的手术和肿瘤学结果。
共分析了 127 例患者（LS 组，n=52；OS 组，n=75）。两组的基线特征相似。行全胃切除术 44 例，切除腹部食管；行远端胃次全切除术 63 例（43 例 Billroth-I 式，20 例 Billroth-II 式）；行近端胃切除术 19 例。腹腔镜手术组的中位手术时间明显长于 OS 组，分别为 253 分钟（IQR，200-295）和 210 分钟（IQR，165-220）（p<0.001），而腹腔镜手术组的术中中位出血量明显少于 OS 组，分别为 180 毫升（IQR，146-214）和 320 毫升（IQR，290-350）（p<0.001）。腹腔镜手术组的早期术后并发症发生率为 35%，OS 组为 45%（p=0.227）。两组术后死亡率无差异（3[6%]例与 5[7%]例，p=1.00）。术后住重症监护病房和术后住院时间明显缩短，分别为 2（IQR，1-2）天与 4（IQR，3-4）天，8（IQR，7-9）天与 10（IQR，8-12）天，均 p<0.001。与 OS 组相比，LS 组患者开始辅助化疗的时间明显更早，分别为 20 天与 28 天（p<0.001）。然而，两组的总生存率相似。LS 组和 OS 组的 3 年总生存率分别为 24%和 27%。
尽管技术复杂，但在患有复杂的局部进展期和转移性胃癌的患者中，与传统的开放手术相比，腹腔镜胃切除术具有手术时间较长、术中出血量减少、康复期较短、发病率、死亡率和长期肿瘤学结果相似的特点。
