Zang M D, Chen J, Zhang Y, Xuan Y, Huang H
Department of Gastric Cancer Surgery, Fudan University Shanghai Cancer Center; Department of Oncology, Shanghai Medical College, Fudan University, Shanghai 200032, China.
Zhonghua Wei Chang Wai Ke Za Zhi. 2022 Aug 25;25(8):726-730. doi: 10.3760/cma.j.cn441530-20220725-00327.
To investigate the safety and feasibility of pure single-port laparoscopic distal gastrectomy (SDG) in the radical treatment of gastric cancer. A retrospective cohort study with propensity score matching (PSM) was conducted. Subjects were included in the study who were diagnosed by imaging examination and pathology as early distal gastric cancer, no distant metastasis, no serious cardiovascular and cerebrovascular diseases and underwent radical gastrectomy. Patients with incomplete clinical data, unplanned second operation and complicated with other tumors were excluded. A retrospective analysis was performed on 15 patients who underwent pure SDG radical gastrectomy for gastric cancer from September 2020 to March 2022, namely the SDG group. Fifty-eight patients undergoing conventional five-port laparoscopic radical gastrectomy for gastric cancer were included as the control group, namely the LDG group. As it was found that there was a statistically significant difference in baseline body mass index (BMI) between the two groups [(20.8±0.8) kg/m vs. (22.9±0.4) kg/m, =2.456, =0.017], one-to-one PSM was conducted between the two groups. Then the basic conditions of the two groups of patients in perioperative period were analyzed and compared. There were 14 patients after PSM in the SDG group and the LDG group respectively. There were no significant differences in intraoperative bleeding, number of lymph nodes dissected, time to the first postoperative feeding and postoperative complications between the SDG group and the LDG group (all >0.05). Compared with LDG group, the operative time in the SDG group was longer [(163.6±6.3) minutes vs. (133.9±4.4) minutes, =3.866, =0.001]. However, in the SDG group, time to the first flatus [(2.6±0.2) days vs. (3.3±0.1) days, =3.053,=0.005], time to drainage tube removal [(4.5±0.8) days vs. (6.9±0.2) days, =2.914, =0.007)] and postoperative hospital stay [(6.7±0.1) days vs. (9.2±1.0) days, =2.534,=0.018)] were significantly shorter, and pain score at the first postoperative day evaluated by NRS (1.86±0.29 vs. 2.86±0.35, =2.205, =0.037) was significantly lower as compared to the LDG group. Four patients in SDG group did not receive peritoneal drainage tube placement after surgery, and they all recovered safely. The pure single-port laparoscopic radical gastrectomy for gastric cancer is safe and feasible, and has an advantage over the LDG in postoperative recovery.
探讨纯单孔腹腔镜远端胃癌根治术（SDG）治疗胃癌的安全性及可行性。进行一项倾向评分匹配（PSM）的回顾性队列研究。纳入经影像学检查及病理确诊为早期远端胃癌、无远处转移、无严重心脑血管疾病且接受根治性胃切除术的患者。排除临床资料不完整、计划外二次手术及合并其他肿瘤的患者。对2020年9月至2022年3月期间接受纯SDG根治性胃癌切除术的15例患者进行回顾性分析，即SDG组。纳入58例行传统五孔腹腔镜根治性胃癌切除术的患者作为对照组，即LDG组。由于发现两组患者基线体重指数（BMI）存在统计学显著差异[（20.8±0.8）kg/m² 对 （22.9±0.4）kg/m²，t = 2.456，P = 0.017]，对两组进行一对一PSM。然后分析比较两组患者围手术期的基本情况。PSM后SDG组和LDG组各有14例患者。SDG组与LDG组在术中出血量、清扫淋巴结数目、术后首次进食时间及术后并发症方面均无显著差异（均P>0.05）。与LDG组相比，SDG组手术时间更长[（163.6±6.3）分钟对（133.9±4.4）分钟，t = 3.866，P = 0.001]。然而，SDG组术后首次排气时间[（2.6±0.2）天对（3.3±0.1）天，t = 3.053，P = 0.005]、引流管拔除时间[（4.5±0.8）天对（6.9±0.2）天，t = 2.914，P = 0.007]及术后住院时间[（6.7±0.1）天对（9.2±1.0）天，t = 2.534，P = 0.018]均显著缩短，且术后第1天采用NRS评估的疼痛评分（1.86±0.29对2.86±0.35，t = 2.205，P = 0.037）显著低于LDG组。SDG组有4例患者术后未放置腹腔引流管，均安全康复。纯单孔腹腔镜根治性胃癌切除术安全可行，在术后恢复方面优于LDG。
