Lu Yi-Ming, Ye Zhi-Bin, Wang Hai-Kuo, Zhong Wen-Hui, Shao Xin-Xin, Hu Hai-Tao, Jiang Yu-Juan, Li Wang-Yao, Tian Yan-Tao
Department of Pancreatic and Gastric Surgery, National Cancer Center/National Clinical Research Center for Cancer/Cancer Hospital, Chinese Academy of Medical Sciences and Peking Union Medical College, 17 Panjiayuannanli, Chaoyang District, Beijing, 100021, China.
Department of Gastrointestinal Surgery, Hebei General Hospital, No. 348 Heping West Road, Shijiazhuang, 050000, Hebei, China.
World J Surg Oncol. 2025 Apr 21;23(1):150. doi: 10.1186/s12957-025-03809-y.
The safety and feasibility of laparoscopic surgery for T4b gastric cancer with transverse colon or mesocolon invasion remain insufficiently characterized. This study aimed to compare the surgical outcomes of laparoscopic and open gastrectomy in individuals with T4b gastric cancer involving these anatomical structures.
A retrospective cohort study was conducted across two centers, including 53 individuals with T4b gastric cancer involving the transverse colon or mesocolon who underwent curative-intent surgery between January 2011 and December 2019. Participants were divided into two groups based on the surgical approach: laparoscopic surgery (n = 32) and open surgery (n = 21). Perioperative outcomes, postoperative complications, and survival outcomes were evaluated and compared.
Baseline characteristics were comparable between the groups. The laparoscopic approach demonstrated significantly reduced intraoperative blood loss compared to open surgery (92.5 ± 101.9 mL vs. 147.6 ± 76.6 mL, p = 0.039). No significant differences were observed in operating time (187.8 ± 52.7 vs. 185.9 ± 52.3 min, p = 0.896), R0 resection rates (93.8% vs. 90.5%, p = 0.659), lymph node yield, or length of postoperative hospital stay. The incidence of postoperative complications was similar between the groups (10.3% vs. 10.5%, p = 0.986). Additionally, mean overall survival (31.4 vs. 27.2 months, p = 0.506) and progression-free survival (26.1 vs. 23.5 months, p = 0.573) did not differ significantly.
Laparoscopic gastrectomy with combined resection appears to be a feasible and safe alternative to open surgery for selected individuals with T4b gastric cancer involving the transverse colon or mesocolon. This approach achieves similar perioperative and long-term clinical outcomes compared to open surgery.
腹腔镜手术治疗侵犯横结肠或结肠系膜的T4b期胃癌的安全性和可行性仍未得到充分描述。本研究旨在比较腹腔镜与开放胃切除术治疗累及这些解剖结构的T4b期胃癌患者的手术效果。
在两个中心进行了一项回顾性队列研究，纳入了53例在2011年1月至2019年12月期间接受根治性手术的累及横结肠或结肠系膜的T4b期胃癌患者。根据手术方式将参与者分为两组：腹腔镜手术组（n = 32）和开放手术组（n = 21）。评估并比较围手术期结局、术后并发症和生存结局。
两组的基线特征具有可比性。与开放手术相比，腹腔镜手术的术中出血量显著减少（92.5±101.9 mL对147.6±76.6 mL，p = 0.039）。手术时间（187.8±52.7对185.9±52.3分钟，p = 0.896）、R0切除率（93.8%对90.5%，p = 0.659）、淋巴结清扫数量或术后住院时间均未观察到显著差异。两组术后并发症的发生率相似（10.3%对10.5%，p = 0.986）。此外，平均总生存期（31.4对27.2个月，p = 0.506）和无进展生存期（26.1对23.5个月，p = 0.573）也无显著差异。
对于部分累及横结肠或结肠系膜的T4b期胃癌患者，腹腔镜联合切除术似乎是一种可行且安全的替代开放手术的方法。与开放手术相比，这种方法可实现相似的围手术期和长期临床结局。
