National University of Singapore, Yong Loo Lin School of Medicine, Singapore, Singapore.
Department of Upper GI and Bariatric Surgery, Singapore General Hospital, Singapore, Singapore.
Asian J Endosc Surg. 2023 Oct;16(4):731-740. doi: 10.1111/ases.13235. Epub 2023 Jul 31.
Completion gastrectomy with lymphadenectomy for remnant gastric cancer (RGC) is currently the gold standard for patients with resectable disease. Multiple surgical approaches can be adopted; however, there exists no agreement on the best choice due to the low incidence of RGC. With its anticipated increase in prevalence, we thus sought to evaluate the feasibility and efficacy of the laparoscopic approach versus conventional laparotomy via a pooled analysis of existing literature.
A retrospective review of five consecutive patients who underwent laparoscopic completion gastrectomy from August 2017 to June 2022 was performed following Institutional Review Board waiver. A comprehensive systematic review of literature on laparoscopic completion gastrectomy from the Pubmed, Embase, MEDLINE, Web of Science and Cochrane databases was conducted to supplement the experience from our institution.
Four patients had prior benign gastric disease and one had prior gastric cancer. Two patients experienced severe postoperative complications but there were otherwise no reports of conversion to laparotomy or mortality. Mean operative duration was 295 minutes. Mean duration to oral intake and discharge was 6.8 and 14.6 days respectively. Results from our pooled analysis of 591 cases suggested that the laparoscopic approach was associated with longer operative durations but delivered fewer postoperative complications, shorter duration to dietary resumption and shorter lengths of stay over conventional laparotomy.
Laparoscopic completion gastrectomy is indeed a more challenging procedure due to the presence of dense adhesions from previous surgery. However, the procedure can be performed safely with superior outcomes as compared to conventional laparotomy.
对于可切除的残胃癌（RGC）患者，完成性胃切除术加淋巴结清扫术目前是金标准。可以采用多种手术方法；然而，由于 RGC 的发病率较低，因此对于最佳选择尚未达成共识。随着 RGC 发病率的预期增加，我们因此试图通过对现有文献的汇总分析，评估腹腔镜与传统剖腹手术相比的可行性和疗效。
在机构审查委员会豁免的情况下，对 2017 年 8 月至 2022 年 6 月期间连续接受腹腔镜完成性胃切除术的五名患者进行了回顾性研究。对来自 Pubmed、Embase、MEDLINE、Web of Science 和 Cochrane 数据库的腹腔镜完成性胃切除术的文献进行了全面的系统回顾，以补充我们机构的经验。
四名患者有先前的良性胃部疾病，一名患者有先前的胃癌。两名患者发生严重术后并发症，但无中转开腹或死亡报告。平均手术时间为 295 分钟。开始口服摄入和出院的平均时间分别为 6.8 天和 14.6 天。我们对 591 例病例的汇总分析结果表明，腹腔镜方法与较长的手术时间相关，但与传统剖腹手术相比，术后并发症较少，恢复饮食的时间较短，住院时间较短。
由于先前手术存在致密粘连，腹腔镜完成性胃切除术确实是一项更具挑战性的手术。然而，与传统剖腹手术相比，该手术可以安全进行，并且具有更好的结果。
