Department of Gastrointestinal Surgery, The First Affiliated Hospital of Zhengzhou University, 1 Jianshe Road, Zhengzhou, 450052, China.
Langenbecks Arch Surg. 2023 Sep 12;408(1):354. doi: 10.1007/s00423-023-03085-y.
To investigate short-term efficacy of direct laparoscopic-assisted radical gastrectomy (LAG) versus non-curative endoscopic submucosal dissection (ESD) plus additional LAG for early gastric cancer.
286 patients were retrospectively assigned into two groups: direct LAG group (n = 255) and additional LAG (ESD plus LAG, n = 31) group. A 1:2 propensity score matching was performed to equalize relevant confounding factors between two groups for analysis.
Ninety-three patients were successfully matched, including 62 in the direct LAG group and 31 in the additional LAG group. A significant (P = 0.013) difference existed in the drainage removal time between the additional LAG and direct LAG group (7 d vs. 6 d). Age, sex, tumor location and surgical approach were significantly (P < 0.05) associated with complications, with age ≥ 60 years (P = 0.002) and total gastrectomy (P = 0.011) as significant independent risk factors. A significant (P = 0.023) difference existed in the surgical time between the early and late groups (193.3 ± 37.6 min vs. 165.5 ± 25.1 min).
Additional LAG (D1 + lymphadenectomy) after ESD may be safe and effective even though non-curative ESD may prolong the drainage removal time and increase the difficulty of surgery.
探讨直接腹腔镜辅助根治性胃切除术（LAG）与非治愈性内镜黏膜下剥离术（ESD）加额外 LAG 治疗早期胃癌的短期疗效。
回顾性分析 286 例患者，分为直接 LAG 组（n=255）和额外 LAG 组（ESD 加 LAG，n=31）。采用 1:2 倾向评分匹配法对两组间相关混杂因素进行均衡分析。
成功匹配 93 例患者，其中直接 LAG 组 62 例，额外 LAG 组 31 例。两组引流拔除时间存在显著差异（P=0.013），额外 LAG 组为 7d，直接 LAG 组为 6d。年龄、性别、肿瘤部位和手术途径与并发症显著相关（P<0.05），年龄≥60 岁（P=0.002）和全胃切除术（P=0.011）是显著的独立危险因素。早期组和晚期组手术时间存在显著差异（P=0.023），分别为 193.3±37.6min 和 165.5±25.1min。
ESD 后行额外 LAG（D1+淋巴结清扫）是安全有效的，尽管非治愈性 ESD 可能会延长引流拔除时间并增加手术难度。
