腹腔镜手术对促进双联辅助化疗的晚期胃癌患者长期生存的临床影响。

Clinical Impact of Laparoscopic Surgery on the Long-term Survival of Advanced Gastric Cancer Patients With Regard to Facilitating Doublet Adjuvant Chemotherapy.

机构信息

Department of Gastroenterological Surgery, Tenri Hospital, Tenri, Japan

Department of Gastroenterological Surgery, Tenri Hospital, Tenri, Japan.

出版信息

Anticancer Res. 2023 May;43(5):2203-2209. doi: 10.21873/anticanres.16383.

DOI:10.21873/anticanres.16383

PMID:37097653

Abstract

BACKGROUND/AIM: The impact of laparoscopic gastrectomy (LG), a standard gastric cancer (GC) management strategy, in advanced GC cases involving doublet adjuvant chemotherapy remains unclear. This study was aimed at comparing short- and long-term LG and open gastrectomy (OG) results.

PATIENTS AND METHODS

Patients who underwent gastrectomy with D2 lymph node dissection for stage II/III GC between 2013 and 2020 were retrospectively analyzed. Patients were divided into two groups: patients undergoing LG (n=96, LG-group) and OG (n=148, OG-group). The primary outcome was relapse-free survival (RFS).

RESULTS

Compared with the OG group, the LG group was associated with a longer operation time (373 vs. 314 min, p<0.001), less blood loss (50 vs. 448 ml, p<0.001), fewer grade 3-4 complications (5.2 vs. 17.1%, p=0.005), and a shorter hospital stay (12 vs. 15 days, p<0.001). More lymph nodes were dissected in the LG group (49 vs. 40, p<0.001). The intergroup difference in prognosis was insignificant [5-year RFS: 60.4% (LG) vs. 63.1% (OG), p=0.825]. The LG group more frequently received doublet adjuvant chemotherapy (46.8 vs. 12.7%, p<0.001) and started treatments within 6 weeks after surgery (71.1% vs. 38.9%, p=0.017), and the completion rate of doublet AC was significantly higher in the LG group (85.4% vs. 58.8%, p=0.027). Compared to OG, LG for stage III GC tended to be associated with improved prognosis (HR=0.61, 95%CI=0.33-1.09, p=0.096).

CONCLUSION

LG for advanced GC may facilitate doublet regimens due to favorable postoperative outcomes and its intervention may contribute to survival benefits.

摘要

背景/目的：腹腔镜胃切除术（LG）作为一种标准的胃癌（GC）管理策略，在涉及双联辅助化疗的晚期 GC 病例中的影响仍不清楚。本研究旨在比较 LG 和开腹胃切除术（OG）的短期和长期结果。

患者和方法

回顾性分析了 2013 年至 2020 年间接受 D2 淋巴结清扫术治疗 II/III 期 GC 的患者。患者分为两组：接受 LG（n=96，LG 组）和 OG（n=148，OG 组）的患者。主要结局是无复发生存（RFS）。

结果

与 OG 组相比，LG 组的手术时间更长（373 分钟 vs. 314 分钟，p<0.001），出血量更少（50 毫升 vs. 448 毫升，p<0.001），III/IV 级并发症更少（5.2% vs. 17.1%，p=0.005），住院时间更短（12 天 vs. 15 天，p<0.001）。LG 组的淋巴结清扫数量更多（49 个 vs. 40 个，p<0.001）。两组间预后差异无统计学意义[5 年 RFS：60.4%（LG）vs. 63.1%（OG），p=0.825]。LG 组更常接受双联辅助化疗（46.8% vs. 12.7%，p<0.001），且在术后 6 周内开始治疗（71.1% vs. 38.9%，p=0.017），LG 组双联 AC 完成率明显更高（85.4% vs. 58.8%，p=0.027）。与 OG 相比，LG 治疗 III 期 GC 可能与改善的预后相关（HR=0.61，95%CI=0.33-1.09，p=0.096）。