Gastrointestinal Surgery Unit 2, The First Affiliated Hospital of Fujian Medical University, Fuzhou, 350004, Fujian, China.
Gastrointestinal Surgery Unit 1, Teaching Hospital of Putian First Hospital of Fujian Medical University, Putian, 351100, Fujian, China.
Surg Endosc. 2023 Jun;37(6):4990-5003. doi: 10.1007/s00464-023-10089-8. Epub 2023 May 8.
Retrospectively analyzed the short- and long-term efficacy between laparoscopic D2 lymphadenectomy plus regional complete mesogastrium excision (D2 + rCME) and traditional laparoscopic D2 in the treatment of patients with locally advanced gastric cancer (LAGC), in order to obtain more evidence for D2 + rCME gastrectomy.
A total of 599 LAGC patients who underwent laparoscopy-assisted radical gastrectomy from January 2014 to December 2019, including 367 cases in the D2 + rCME group and 232 cases in the D2 group. Intraoperative and postoperative clinicopathological parameters, postoperative complications and long-term survival in the two groups were statistically analyzed.
No significant differences in the positive rate of mesogastric tumor deposits, the number of positive lymph nodes and postoperative length of stay were found between the two groups (P > 0.05). In the D2 + rCME group, intraoperative blood loss was significantly reduced (84.20 ± 57.64 ml vs. 148.47 ± 76.97 ml, P < 0.001), the time to first postoperative flatus and first liquid diet intake were significantly shortened (3[2-3] days vs. 3[3-3] days, P < 0.001; 7[7-8] days vs. 8[7-8] days, P < 0.001), and the number of lymph nodes dissected was greater (43.57 ± 16.52 pieces vs. 36.72 ± 13.83 pieces, P < 0.001). The incidence of complications did not significantly differ between the D2 + rCME group (20.7%) and D2 group (19.4%) (P > 0.05). Although there was no statistically difference in 3-year OS and DFS between the two groups. However, the trend was better in D2 + rCME group. In subgroup analysis, patients with positive tumor deposits (TDs) in the D2 + rCME group had significantly better 3-year DFS compared With D2 group (P < 0.05).
Laparoscopic D2 + rCME is safe and feasible for the treatment of LAGC and is characterized by less bleeding, greater lymph node dissection and rapid recovery, without increasing postoperative complications. D2 + rCME group showed a better trend of long-term efficacy, especially significant beneficial for LAGC patients who with positive TDs.
回顾性分析腹腔镜下 D2 淋巴结清扫术+区域完整中系膜切除术（D2+rCME）与传统腹腔镜下 D2 治疗局部进展期胃癌（LAGC）的短期和长期疗效，为 D2+rCME 胃切除术提供更多证据。
2014 年 1 月至 2019 年 12 月，599 例 LAGC 患者接受腹腔镜辅助根治性胃切除术，其中 D2+rCME 组 367 例，D2 组 232 例。对两组患者的术中及术后临床病理参数、术后并发症及长期生存情况进行统计学分析。
两组间中系膜肿瘤沉积物阳性率、阳性淋巴结数量及术后住院时间差异均无统计学意义（P>0.05）。D2+rCME 组术中出血量明显减少（84.20±57.64 ml 比 148.47±76.97 ml，P<0.001），首次术后肛门排气时间及首次流质饮食时间明显缩短（3[2-3]天比 3[3-3]天，P<0.001；7[7-8]天比 8[7-8]天，P<0.001），淋巴结清扫数目增加（43.57±16.52 枚比 36.72±13.83 枚，P<0.001）。D2+rCME 组并发症发生率与 D2 组差异无统计学意义（20.7%比 19.4%，P>0.05）。两组患者 3 年 OS 和 DFS 差异无统计学意义，但 D2+rCME 组趋势较好。亚组分析显示，D2+rCME 组中肿瘤沉积物阳性（TDs）患者的 3 年 DFS 明显优于 D2 组（P<0.05）。
腹腔镜 D2+rCME 治疗 LAGC 安全可行，具有出血少、淋巴结清扫量大、恢复快的特点，不增加术后并发症。D2+rCME 组显示出更好的长期疗效趋势，特别是对 TDs 阳性的 LAGC 患者有明显的获益。
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