Department of Gastroenterological Surgery, Osaka International Cancer Institute, 3-1-69 Otemae, Chuo-ku, Osaka, 541-8567, Japan.
J Gastrointest Surg. 2022 Oct;26(10):2041-2049. doi: 10.1007/s11605-022-05404-y. Epub 2022 Aug 29.
Laparoscopic total gastrectomy for early proximal gastric cancer is widely performed. Recently, the number of laparoscopic proximal gastrectomies performed, a surgery limited to early proximal gastric cancer, has gradually increased. However, evidence for the long-term outcomes of laparoscopic total gastrectomy and laparoscopic proximal gastrectomy is insufficient. Therefore, this study aimed to clarify and compare the long-term outcomes of laparoscopic total gastrectomy and laparoscopic proximal gastrectomy with novel valvuloplastic esophagogastrostomy for treatment of clinical stage I proximal gastric cancer.
This study included 111 patients who underwent laparoscopic total gastrectomy or laparoscopic proximal gastrectomy for the treatment of upper third clinical stage I gastric cancer between April 2004 and December 2017. After adjusting for propensity score matching analysis, we compared the postoperative complications, nutritional status, and long-term outcomes between the two groups.
After matching the inclusion criteria, 56 patients (28 in each group) were enrolled. No significant differences were noted in the postoperative complications between the two groups. While laparoscopic proximal gastrectomy was associated with lower albumin levels, lower body weight loss was seen by 1 year after surgery and higher hemoglobin levels by 1, 2, and 3 years after surgery. No significant differences were observed in the 3-year overall survival and 3-year recurrence-free survival between the laparoscopic total gastrectomy and laparoscopic proximal gastrectomy groups (P = 0.74 and 0.72, respectively).
Laparoscopic proximal gastrectomy and laparoscopic total gastrectomy for patients with upper third clinical stage I gastric cancer are feasible as regards its safety and outcomes.
腹腔镜全胃切除术已广泛应用于早期近端胃癌的治疗。近年来，腹腔镜近端胃切除术的数量逐渐增加，该手术仅限于早期近端胃癌。然而，腹腔镜全胃切除术和腹腔镜近端胃切除术的长期疗效证据尚不充分。因此，本研究旨在阐明和比较腹腔镜全胃切除术和腹腔镜近端胃切除术联合新型瓣膜成形食管胃吻合术治疗临床Ⅰ期近端胃癌的长期疗效。
本研究纳入了 2004 年 4 月至 2017 年 12 月期间接受腹腔镜全胃切除术或腹腔镜近端胃切除术治疗上三分之一临床Ⅰ期胃癌的 111 例患者。通过倾向评分匹配分析调整后，比较了两组患者的术后并发症、营养状况和长期疗效。
符合纳入标准后，共有 56 例患者（每组 28 例）被纳入研究。两组患者的术后并发症无显著差异。虽然腹腔镜近端胃切除术与较低的白蛋白水平相关，但术后 1 年体重减轻较少，术后 1、2 和 3 年血红蛋白水平较高。腹腔镜全胃切除术组和腹腔镜近端胃切除术组的 3 年总生存率和 3 年无复发生存率无显著差异（P=0.74 和 0.72）。
对于上三分之一临床Ⅰ期胃癌患者，腹腔镜近端胃切除术和腹腔镜全胃切除术在安全性和疗效方面是可行的。
