Cao Ce, Tian Xue, Wang Xue-Zhao, Wang Qing
Department of Gastrointestinal Surgery, Zibo Central Hospital, Zibo 255036, Shandong Province, China.
Department of Oncology, Zibo Central Hospital, Zibo 255036, Shandong Province, China.
World J Gastrointest Surg. 2024 Dec 27;16(12):3786-3793. doi: 10.4240/wjgs.v16.i12.3786.
Gastric cancer surgery has advanced with minimally invasive techniques. This study compares outcomes between single-incision laparoscopic surgery plus one port (SILS + 1) and conventional laparoscopic surgery (CLS) in treating gastric cancer.
To explore the curative effect of SILS + 1 and CLS on gastric cancer and their influences on prognosis.
A total of 93 patients with gastric cancer undergoing radical gastrectomy in the hospital were retrospectively analyzed between September 2019 and September 2022. According to different surgical methods, they were divided into SILS + 1 group ( = 56) and CLS group ( = 37). The perioperative indexes, pain degree [visual analogue scale (VAS)] and stress response [C-reactive protein (CRP), white blood cell count (WBC)] in the two groups were compared. The postoperative complications, recurrence rate and mortality at 1 year after surgery were recorded.
Intraoperative blood loss was significantly lower in the SILS + 1 group (76.53 ± 8.12 mL) compared to the CLS group (108.67 ± 12.34 mL, < 0.001), and the total incision length was also significantly shorter in the SILS + 1 group (5.29 ± 1.01 cm 9.45 ± 2.34 cm, < 0.001). SILS + 1 patients experienced faster recovery, with shorter times to first flatus (1.94 ± 0.43 days 3.23 ± 0.88 days, < 0.001) and ambulation (2.76 ± 0.58 days 4.10 ± 0.97 days, < 0.001). Postoperative pain, as measured by VAS scores, was significantly lower in the SILS + 1 group on postoperative days 1, 2, and 3 ( < 0.001). Additionally, stress markers (CRP and WBC) were significantly lower in the SILS + 1 group on the first postoperative day (CRP: 6.41 ± 1.63 mg/L 7.82 ± 1.88 mg/L, < 0.001; WBC: 6.34 ± 1.50 × 10/L 7.09 ± 1.61 × 10/L, = 0.024). The complication rate in the SILS + 1 group was also significantly lower than in the CLS group (8.93% 27.03%, = 0.020). However, there was no significant difference in recurrence rates between the two groups after one year (3.57% 8.11%, > 0.05).
SILS + 1 and CLS have the comparable lymph node clearance effect in patients with gastric cancer. However, SILS + 1 is more beneficial to reduce intraoperative blood loss, relieve pain, alleviate stress response, reduce the incidence of complications and promote rapid postoperative recovery.
胃癌手术已随着微创技术而取得进展。本研究比较单孔腹腔镜手术加一个辅助端口（SILS + 1）与传统腹腔镜手术（CLS）治疗胃癌的效果。
探讨SILS + 1和CLS对胃癌的治疗效果及其对预后的影响。
回顾性分析2019年9月至2022年9月期间在本院接受根治性胃切除术的93例胃癌患者。根据不同手术方式，将他们分为SILS + 1组（n = 56）和CLS组（n = 37）。比较两组的围手术期指标、疼痛程度[视觉模拟评分法（VAS）]和应激反应[C反应蛋白（CRP）、白细胞计数（WBC）]。记录术后并发症、术后1年的复发率和死亡率。
SILS + 1组术中失血量（76.53 ± 8.12 mL）显著低于CLS组（108.67 ± 12.34 mL，P < 0.001），且SILS + 1组的总切口长度也显著短于CLS组（5.29 ± 1.01 cm vs 9.45 ± 2.34 cm，P < 0.001）。SILS + 1组患者恢复更快，首次排气时间（1.94 ± 0.43天 vs 3.23 ± 0.88天，P < 0.001）和下床活动时间（2.76 ± 0.58天 vs 4.10 ± 0.97天，P < 0.001）更短。术后第1、2和3天，SILS + 1组的VAS评分所测得的术后疼痛显著更低（P < 0.001）。此外，术后第1天SILS + 1组的应激指标（CRP和WBC）显著更低（CRP：6.41 ± 1.63 mg/L vs 7.82 ± 1.88 mg/L，P < 0.001；WBC：6.34 ± 1.50×10⁹/L vs 7.09 ± 1.61×10⁹/L，P = 0.024）。SILS + 1组的并发症发生率也显著低于CLS组（8.93% vs 27.03%，P = 0.020）。然而，两组术后1年的复发率无显著差异（3.57% vs 8.11%，P > 0.05）。
SILS + 1和CLS在胃癌患者中具有相当的淋巴结清扫效果。然而，SILS + 1更有利于减少术中失血、缓解疼痛、减轻应激反应、降低并发症发生率并促进术后快速恢复。
