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1.
目的 探讨进展期胃癌腹腔镜根治术的安全性和可行性,并评价其远期临床疗效。方法 对2004年1月至2009年6月远端进展期胃癌行腹腔镜辅助胃癌根治术346例患者的临床及随访资料和同期在我院行传统开腹胃癌手术的313例进行回顾性分析,比较两组的手术安全性、术后并发症、生存率以及癌症复发转移情况。结果 腹腔镜组手术平均用时与开腹组相比差异无统计学意义[(211±56) min比(204±41)min,P>0.05]。腹腔镜组术中出血量、切口长度显著低于开腹手术组。腹腔镜组肿瘤近、远端切缘长度分别为(6.3±2.0) cm、(5.7±1.7)cm,开腹组分别为(6.3±2.1) cm、(5.6±1.6) cm,两组相比差异均无统计学意义。腹腔镜组淋巴结清扫数量为(33±13)枚,开腹组为(33±16)枚,两组相比差异无统计学意义。腹腔镜组术后并发症的发生率显著低于开腹组(6.7%比13.1%,P<0.01)。随访时间6~72个月,平均37个月,腹腔镜组1、3、5年生存率分别为87.2%、57.2%和50.3%,开腹组分别为87.1%、54.1%和49.2%,两组相比差异均无统计学意义。两组癌症复发转移率相比差异无统计学意义。结论 腹腔镜辅助的进展期胃癌根治术与开腹组在生存率及术后复发方面无显著差异,且具有创伤小、术后恢复快、并发症少等优点。 相似文献
2.
Kunisaki C Makino H Takagawa R Oshima T Nagano Y Ono HA Akiyama H Shimada H 《Surgical endoscopy》2009,23(2):377-383
Background To date, it has been unclear whether laparoscopy-assisted distal gastrectomy (LADG) is a suitable treatment for elderly patients
with early gastric cancer. This study retrospectively compared surgical outcomes between elderly and nonelderly patients with
gastric cancer.
Methods The study group was comprised of 211 patients who underwent distal gastrectomy between April 2000 and March 2007. Of these,
130 patients (26 aged ≥75 years and 104 aged <75 years) underwent LADG, and the remaining 81 patients underwent conventional
open distal gastrectomy (ODG). Short- and long-term patient outcomes were evaluated.
Results The operation time was significantly longer in the LADG group than in the ODG group (262.6 versus 234.3 min, p = 0.005), but the other short-term outcomes did not differ between the two groups. When performed by an experienced surgeon,
blood loss was significantly reduced, while operation time for LADG was similar to that for ODG. Within the LADG group, incidences
of comorbid disease and lymph-node metastasis were significantly greater, the histological tumor type was significantly more
differentiated, and the macroscopically depressed tumor type was less common in elderly patients. However, the incidence of
postoperative morbidity did not differ between the elderly and nonelderly groups (11.5% versus 3.8%, p = 0.1201), and there was no significant difference in postoperative course. Logistic regression analysis showed that body mass
index, but not chronological age, was an independent predictive factor of postoperative morbidity (odds ratio = 3.674, p = 0.045). There were no significant differences in overall or disease-specific survival between elderly and nonelderly patients.
Conclusion LADG is an effective treatment for elderly patients with early gastric cancer if it is performed by an experienced surgeon.
A high-volume study is needed to confirm this rationale. 相似文献
3.
Chang Hak Yoo Hyung Ook Kim Sang Il Hwang Byung Ho Son Jun Ho Shin Hungdai Kim 《Surgical endoscopy》2009,23(10):2250-2257
Background
Laparoscopy-assisted distal gastrectomy (LADG) is gaining wider acceptance for treating early gastric cancer (EGC). However, many gastric surgeons are still reluctant to perform LADG, mainly because this procedure entails a considerable learning curve. We aimed to evaluate the technical feasibility and short-term outcomes of performing LADG by a single experienced gastric surgeon who initially had no experience with laparoscopic surgery as compared with open distal gastrectomy (ODG).Methods
Between January 2006 and December 2007, 177 patients with preoperatively diagnosed EGC located at the middle or lower third of the stomach were enrolled; 102 patients underwent LADG, 4 patients had open conversion, and 71 patients underwent conventional ODG. The operative and early postoperative outcomes from a prospective database were compared between the two groups.Results
The clinicopathological characteristics were similar between the two groups. No operation-related deaths occurred. Although operation time was significantly longer for LADG than for ODG, time to first flatus was shorter and, consequently, postoperative hospital stay was significantly shorter in the LADG group. There was no significant difference in the overall complication rates between the two groups. On comparing the early (n = 50) and late groups (n = 52) of LADG patients, operation time and postoperative hospital stay were shorter and number of retrieved lymph nodes was greater in the late group (p < 0.05). Major and minor complications were markedly reduced in the late group (p < 0.05).Conclusions
Although LADG was more time consuming than ODG, it was a feasible, safe procedure that accomplished the oncological requirements. Postoperative morbidity of LADG was similar to that of ODG, and LADG led to faster postoperative recovery. However, LADG should be performed carefully to prevent unexpected complications, especially during the early learning period. 相似文献4.
Background Laparoscopy-assisted distal gastrectomy (LADG) with lymph node dissection for advanced gastric cancer is still controversial.
To evaluate the technical and oncologic feasibility and advantage of LADG with D2 lymph node dissection, the authors compared
the surgical outcomes of LADG with D2 dissection and those of conventional open distal gastrectomy (ODG) for patients with
early gastric cancer (EGC).
Methods Between September 2004 and August 2005, the study enrolled 75 patients with a preoperative diagnosis of EGC. Of these 75 patients,
44 underwent LADG, and remaining 31 underwent ODG. All the patients received D2 lymph node dissection. Their clinicopathologic
characteristics, postoperative outcomes, and retrieved lymph nodes were compared at each station.
Results Although the operative time was significantly longer for the LADG group than for the ODG group, the perioperative recovery
was shorter and, consequently, the postoperative hospital stay was significantly shorter for the LADG group (7.7 vs 9.4 days,
respectively; p = 0.003). No significant differences were found in the total number of retrieved lymph nodes (37.2 vs 42.4; p > 0.05) or node stations (p > 0.05) between the two groups.
Conclusions LADG with D2 lymph node dissection is a safe and feasible procedure, and it is oncologically compatible with open gastrectomy.
A large-scaled prospective randomized trial with advanced gastric cancer patients should be conducted to confirm the benefit
of LADG.
Part of this article was presented and awarded the Best Video Award at the 14th International Congress of EAES, Berlin, Germany,
13–16 September 2006 相似文献
5.
Sang Eok Lee MD Young-Woo Kim MD Jun Ho Lee MD Keun Won Ryu MD Soo Jeong Cho MD Jong Yeul Lee MD Chan Gyoo Kim MD Il Ju Choi MD Myeong-Cherl Kook MD Byung-Ho Nam PhD Sook Ryun Park MD Min Ju Kim MD Jong Seok Lee MD 《Annals of surgical oncology》2009,16(8):2231-2236
Background The technical difficulty of lymph node dissection in laparoscopy-assisted distal gastrectomy (LADG) remains a barrier for
extending the indication for this modality and limits its widespread clinical practice. The aim of this study was to evaluate
our institutional guidelines for LADG, limiting the indications for this modality to only clinical stage T1N0 or T1N1 gastric
cancer.
Methods From January 2002 to October 2006, a total of 294 cases of LADG and 664 cases of open distal gastrectomy (ODG) for clinical
T1N0 or T1N1 gastric cancer were performed at the National Cancer Center, Korea. The two groups’ clinicopathologic characteristics,
surgical outcome, morbidity, and survival were compared.
Results The mean operating time for the LADG group was significantly longer than that for the ODG group (265.8 ± 56.3 vs. 171.4 ± 43.1
minutes, P < .001). The mean number of retrieved lymph nodes in the LADG group was higher than that of the ODG group (39.5 ± 14.7 vs.
37.2 ± 12.9, P = .017). The postoperative hospital stay was shorter in the LADG group (8.0 ± 3.3 vs. 10.5 ± 4.1 days, P < .001). The complications rate was lower for the LADG group than that for the ODG group (6.8% vs. 11.3%, P = .032). The overall survival rate was not significantly different between the two groups (P = .880).
Conclusions Before considering expanding the indications for LADG, developing a carefully thought-out guideline and conducting an audit
are mandatory. 相似文献
6.
Laparoscopic-assisted distal gastrectomy versus open distal gastrectomy for advanced gastric cancer 总被引:1,自引:0,他引:1
Background Laparoscopic-assisted gastric surgery has become an option for the treatment of early gastric cancer. However, there are few
reports of laparoscopic surgery in the management of advanced gastric cancer. In this study we describe our experience with
laparoscopic-assisted distal gastrectomy (LADG) for advanced gastric cancer (AGC).
Methods Between November 2004 and June 2007, 47 patients with AGC underwent LADG at our hospital, and 45 of those patients were enrolled
in this study. These patients were compared with 83 patients who had AGC and underwent conventional open distal gastrectomy
(ODG) during the same period.
Results Operation time was significantly longer in the LADG group than in the ODG group. Estimated blood loss in the LADG group was
significantly less than in the ODG group. Time to ambulation and first flatus and duration of analgesic medication were significantly
shorter in the LADG group. The morbidity and mortality rate were also lower than in the ODG group, with no statistically significant
difference. The distance of the proximal resection margin showed no significant difference compared with ODG (6.3 ± 0.9 versus
6.5 ± 0.9 cm; p = 0.228). The mean number of nodes resected with LADG was 35.6 ± 14.2, and that with ODG was 38.3 ± 11.4 (p = 0.269). The mean follow-up for the LADG group was 23.6 months (range 9–40 months). In the LADG group, recurrence was observed
in six patients (13.3%). Three patients had recurrence and died after 10 (IIIB), 11 (IIIA), and 13 (IIIB) months.
Conclusions LADG with extended lymphadenectomy for AGC is a feasible and safe procedure and has several advantages. Moreover, this method
can achieve a radical oncologic equivalent resection. Indications for LADG with extended lymphadenectomy could be expanded
in the treatment of locally advanced gastric cancer. 相似文献
7.
Comparative study of laparoscopy-assisted distal gastrectomy and open distal gastrectomy 总被引:12,自引:0,他引:12
Lee SI Choi YS Park DJ Kim HH Yang HK Kim MC 《Journal of the American College of Surgeons》2006,202(6):874-880
BACKGROUND: Most studies comparing surgical results of laparoscopic procedures for gastric cancer with open gastrectomies have been conducted based on limited experience. We aimed to compare laparoscopy-assisted distal gastrectomy (LADG) and conventional open distal gastrectomy (ODG) after a protracted learning experience. STUDY DESIGN: We retrospectively reviewed medical records data. Two hundred fifty six patients underwent distal gastrectomies (136 LADG, 120 ODG). There were 150 early gastric cancer (EGC) patients (120 LADG, 30 ODG). RESULTS: Mean operation times for LADG and ODG were similar among EGC (156.5 versus 159.3 minutes, p = 0.666). Mean retrieved lymph node counts for LADG and ODG were different, but were > 30 (31.3 versus 40.4 for all and 30.4 versus 38.1 for EGC). For all subjects or EGC patients after LADG, C-reactive proteins on day 5 were substantially lower, first liquid diet was resumed substantially sooner, and postoperative hospital stays were substantially shorter than for ODG. CONCLUSIONS: LADG with lymph node dissection after a learning curve has several advantages compared with ODG, namely, less inflammatory reaction, rapid return of gastrointestinal function, and shorter hospital stay without compromising operation time or operative curability. 相似文献
8.
Jun Ho Lee Byung-Ho Nam Keun Won Ryu Seong Yeop Ryu Young Woo Kim Young Kyu Park Sung Kim 《Surgical endoscopy》2016,30(2):430-436
Background
Survival data of patients who underwent laparoscopy assisted distal gastrectomy (LADG) compared with those of patients who underwent open distal gastrectomy (ODG) for gastric cancer are rarely presented. We compared long-term outcomes of LADG with those of ODG in patients with EGC who met the current indication for LADG.Methods
A total of 2410 patients with early gastric cancer who underwent curative-intent gastric cancer surgery in three Korean tertiary hospitals between January 2003 and June 2009 were included in this multicenter, retrospective, propensity-score-matched cohort study. Cox proportional hazard regression models were used to evaluate the association between operation methods and survival.Results
In the matched cohort, there were no significant differences in overall survival [hazard ratio (HR) for the LADG group 0.990; 95 % confidence interval (CI) 0.675–1.453] or recurrence-free survival (HR 0.989; 95 % CI 0.480–2.038). The patterns of recurrence were not different between the two groups. The most common pattern of recurrence was liver metastasis followed by metastasis to distant lymph nodes. The rate of complications in the LADG group was higher than that of the ODG group (6.7 vs. 4.6 %, P = 0.045). Grade III or worse complications that required surgical intervention or were life-threatening showed a marginal difference between the two groups (1.7 vs. 2.2 %, P = 0.052). There were no postoperative mortalities in either group.Conclusion
Laparoscopy assisted distal gastrectomy for patients with early gastric cancer is feasible in terms of the long-term results including survival and recurrence.9.
A prospective randomized study comparing open vs laparoscopy-assisted distal gastrectomy in early gastric cancer: early results 总被引:15,自引:0,他引:15
Background We conducted a prospective randomized trial to compare laparoscopy-assisted distal gastrectomy (LADG) including lymphadenectomy with open distal gastrectomy for the management of early gastric cancer (EGC).Methods Forty-seven patients who had been diagnosed endoscopically with EGC were included in a study that ran from November 2001 to August 2003. With the aid of random number table, 23 patients were assigned to the open group (group O) and 24 patients were assigned to the LADG group (group L).Results Estimated blood loss and transfusion amounts were similar in the two groups. The mean postoperative hospital stay and the duration of analgesic administration were shorter for group L but not significantly so. The mean number of harvested lymph nodes was 38.1 in the O group and 31.8 in the L group (p = 0.098). Postoperative pulmonary complications occurred more frequently in the O group (p = 0.043). At a median follow-up of 14 months, there has been no recurrence of disease in either group.Conclusion In terms of resulting in fewer pulmonary complications while maintaining the curability of EGC, LADG has a clear advantage over its open counterpart. 相似文献
10.
Young-Woo Kim Hong Man Yoon Young Ho Yun Byung Ho Nam Bang Wool Eom Yong Hae Baik Sang Eok Lee Yeji Lee Young-ae Kim Ji Yeon Park Keun Won Ryu 《Surgical endoscopy》2013,27(11):4267-4276
Background
The purpose of this study was to evaluate laparoscopy-assisted distal gastrectomy (LADG) compared to open distal gastrectomy (ODG) in the treatment of early gastric cancer with respect to survival, surgical outcomes, complications, and quality of life (QOL).Methods
One hundred sixty-four patients with cT1N0M0 and cT1N1M0 distal gastric cancer were randomly assigned to either the LADG group or the ODG group. The primary end point was the 5-year disease-free survival (DFS) rate. Complications were classified using the accordion severity classification of postoperative complications scheme. QOL was measured using the European Organization for Research and Treatment of Cancer QLQ-C30 and QLQ-STO22 preoperatively and postoperatively during regular follow-up visits. This trial is registered at ClinicalTrials.gov (NCT00546468).Results
The median (range) follow-up period was 74.3 (24.8–90.8) months. The LADG and ODG groups showed similar survival [5-year DFS rate: 98.8 % vs. 97.6 %, respectively (P = 0.514), 5-year overall survival (OS) rate: 97.6 vs. 96.3 %, respectively (P = 0.721)] or overall complication rate (29.3 vs. 42.7 %, respectively; P = 0.073). Mild complications were significantly less frequent in the LADG group than in the ODG group (23.2 vs. 41.5 %; P = 0.012). The rates of moderate, severe, and long-term complications (i.e., 31 days to 5 years after surgery) did not differ significantly between groups. No clinically meaningful differences were detected between the two groups in long-term QOL.Conclusion
LADG showed similar DFS and OS compared to ODG in treating early gastric cancer. Marginal benefits in mild complications were observed with LADG. LADG did not show advantages over ODG regarding other complications and long-term QOL. 相似文献11.
Hiroshi Ohtani Yutaka Tamamori Kozo Noguchi Takashi Azuma Shunsuke Fujimoto Hiroko Oba Tetsuya Aoki Mieko Minami Kosei Hirakawa 《Journal of gastrointestinal surgery》2010,14(6):958-964
Background
We conducted a meta-analysis to evaluate and compare the advantages of laparoscopy-assisted distal gastrectomy (LADG) over open distal gastrectomy (ODG) for treating early gastric cancer (EGC). 相似文献12.
Objectives The aim was to conduct a meta-analysis of the randomized evidence to determine the relative merits of laparoscopic assisted
(LADG) and open (ODG) distal gastrectomy for proven gastric cancer.
Data sources and review methods A search of the Medline, Embase, Science Citation Index, Current Contents, and PubMed databases identified all randomized
clinical trials (RCTs) that compared LADG and OGD and were published in the English language between January 1990 and the
end of June 2007. The meta-analysis was prepared in accordance with the Quality of Reporting of Meta-analyses (QUOROM) statement.
The eight outcome variables analysed were operating time, blood loss, retrieval of lymph nodes, oral intake, hospital stay,
postoperative complications, tumor recurrence, and mortality. Random effects meta-analyses were performed using odds ratios
(OR) and weighted mean differences (WMD).
Results Four trials were considered suitable for meta-analysis. A total of 82 patients underwent LADG and 80 had ODG. For only one
of the eight outcomes, the summary point estimates favoured LADG over ODG; there was a significant reduction of 104.26 ml
in intraoperative blood loss for LADG (WMD, −104.26, 95% confidence interval (CI) −189.01 to −19.51; p = 0.0159). There was however a 83.08 min longer duration of operating time for the LADG group compared with the ODG group
(WMD 83.08, 95% CI 40.53 to 125.64; p = 0.0001) and significant reduction in lymph nodes harvesting of 4.34 lymph nodes in the LADG group (WMD −4.3, 95% CI −6.66
to −2.02; p = 0.0002). Other outcome variables such as time to commencement of oral intake (WMD −0.97, 95% CI −2.47 to 0.54; p = 0.2068), duration of hospital stay (WMD −3.32, 95% CI −7.69 to 1.05; p = 0.1365), rate of complications (OR 0.66, 95% CI 0.27 to 1.60; p = 0.3530), mortality rates (OR 0.94, 95% CI 0.21 to 4.19; p = 0.9363), and tumor recurrence (OR 1.08, 95% CI 0.42 to 2.79; p = 0.8806) were not found to be statistically significant for either group. However, for commencement of oral intake, duration
of hospital stay, and complication rate, the trend was in favor of LADG.
Conclusion LADG was associated with a significantly reduced rate of intraoperative blood loss, at the expense of significantly longer
operating time and significantly reduced lymph node retrieval compared to its open counterpart. Mortality and tumor recurrence
rates were similar between the two groups. Furthermore, time to commencement of oral intake, postprocedural discharge from
hospital, and perioperative complication rate, although not significantly different between the two groups, did suggest a
positive trend toward LADG. Based on this meta-analysis, the authors cannot recommend the routine use of LADG over ODG for
the treatment of distal gastric cancer. However, significant limitations exist in the interpretation of this data due to the
limited number of published randomised control trials, the small sample sizes to date, and the limited duration of follow
up. Further large multicentre randomized controlled trials are required to delineate significantly quantifiable differences
between the two groups. 相似文献
13.
Andrew C. Gordon Kazuyuki Kojima Mikito Inokuchi Keiji Kato Kenichi Sugihara 《Surgical endoscopy》2013,27(2):462-470
Background
The use of laparoscopy-assisted distal gastrectomy (LADG) in advanced gastric cancer (AGC) remains a controversial topic, mainly because of doubts about its oncologic validity. To date, literature on the prognosis for AGC after LADG is scarce. This study evaluated the procedure’s long-term benefits compared with those of the conventional, open distal gastrectomy (ODG).Methods
This study involved 201 patients, 66 of whom underwent LADG, with a mean follow-up period of 49.2 months, from January 1999 to March 2010. A clear set of criteria was used to select patients (including no evidence of lymph node metastasis) and surgeons (subject to their experience). Survival outcomes were assessed by Kaplan–Meier analysis and log-rank testing. The postoperative recovery and complications of the patients also were monitored.Results
No significant difference was observed between LADG and ODG in terms of overall survival or disease-specific survival. The corresponding 5-year survival rates for individual tumor node metastasis stages also were comparable in each group. The number of lymph nodes harvested was similar in the two groups, although the operation time was significantly shorter for ODG. The postoperative hospital stay was shorter for LADG patients (average stay of 8.4 vs. 18.1 days in the ODG group; p < 0.001), and the postoperative complication rate was almost half that for ODG (13.6 vs. 25.0 %; p = 0.048).Conclusion
The combination of the long- and short-term data indicates that LADG should be considered as a feasible alternative to ODG for the treatment of AGC. Its widespread integration requires the accumulation of similar results across multiple centers worldwide. 相似文献14.
Inspection of Safety and Accuracy of D2 Lymph Node Dissection in Laparoscopy-Assisted Distal Gastrectomy 总被引:2,自引:1,他引:1
Kawamura H Homma S Yokota R Yokota K Watarai H Hagiwara M Sato M Noguchi K Ueki S Kondo Y 《World journal of surgery》2008,32(11):2366-2370
Background There is a consensus on the indication of laparoscopy-assisted distal gastrectomy (LADG) for early gastric cancer that needs
D1 + α or D1 + β lymph node dissection. However, many gastrointestinal surgeons consider D2 lymph node dissection in LADG
to be difficult, therefore, only a few medical institutions have performed D2 lymph node dissection in LADG. We examined the
safety and accuracy of D2 dissection in LADG by comparing with open distal gastrectomy (ODG), as the first step to operate
on advanced gastric cancer.
Methods The study population comprised 53 and 67 patients who underwent D2 dissection in LADG or ODG, respectively; with the diagnosis
of preoperative depth grade SM, between 2004 and 2006. In D2 lymph node dissection, difficult points are dissections of lymph
node along the superior mesenteric vein (No. 14v), along the hepatic artery (No. 12a), and along the proximal splenic artery
(No. 11p). We performed these lymph nodes dissection in a fixed process, which was achieved through all improvements.
Results No significant difference was observed in age, sex, American Society of Anesthesiology (ASA) classification, body mass index
(BMI), and operative time between two groups. Bleeding volume was significantly lower in LADG (96.5 ± 126.3 ml) than in ODG
(221.9 ± 174.8 ml). There was no significant difference in number of dissected lymph nodes between ODG (44.8 ± 15.6) and LADG
(49.2 ± 16.1), with no significant difference in degree of pathological stage. The postoperative complication rate was 16.4%
for ODG and 5.7% for LADG, and postoperative hospital stay was significantly shorter for LADG (16.7 ± 5.6 days) than for ODG
(21 ± 11.4 days).
Conclusions D2 dissection in LADG can be performed without problems with safety and accuracy, if the surgical team is skilled in the procedures
of LADG. 相似文献
15.
Jin chen Hu Li xin Jiang Li Cai Hai tao Zheng San yuan Hu Hong bing Chen Guo chang Wu Yi fei Zhang Zhong chuan Lv 《Journal of gastrointestinal surgery》2012,16(10):1830-1839
Objective
The aim of this study was to evaluate the safety and effectiveness of fast-track surgery combined with laparoscopy-assisted radical distal gastrectomy for gastric cancer.Methods
Eighty-eight eligible patients were randomly assigned into four groups: (1) fast-track surgery (FTS) + laparoscopy-assisted radical distal gastrectomy (LADG), treated with LADG and FTS treatment; (2) LADG, treated with LADG and traditional treatment; (3) FTS + open distal grastectomy (ODG), treated with ODG and FTS treatment; and (4) ODG, treated with ODG and traditional treatment. The clinical parameters and serum indicators were compared.Results
Compared with the ODG group, the other three groups had earlier first flatus and shorter postoperative hospital stay (all P?<0.01; all P?<0.05), especially in the FTS + LADG group. The level of ALB was higher in the FTS + LADG group than in the LADG group at 4 and 7 days after surgery (P?<0.05, P?<0.01). The level of CRP in the FTS + LADG group was lower than in the FTS+ODG group at 4 and 7 days after surgery (P?<0.05, P?<0.05). The FTS + ODG group had lowest medical costs.Conclusion
Combination of FTS and LADG in gastric cancer is safe, feasible, and efficient and can improve nutritional status, lessen postoperative stress, and accelerate postoperative rehabilitation. Compared with FTS + ODG and LADG, its advantages were limited in short-term follow-up. 相似文献16.
Hiroyuki Yamada Kazuyuki Kojima Mikito Inokuchi Tatsuyuki Kawano Kenichi Sugihara 《Journal of gastrointestinal surgery》2008,12(6):997-1004
Objective The aim of this study was to compare outcomes between laparoscopy-assisted distal gastrectomy (LADG) and open distal gastrectomy
(ODG) in obese and non-obese patients.
Methods Subjects comprised 248 consecutive patients who underwent distal gastrectomy for gastric cancer between January 1999 and December
2005. Patients with body mass index (BMI) ≥ 25 kg/m2 were defined as obese, and patients with BMI < 25 kg/m2 were defined as non-obese. Parameters analyzed included patients characteristics, tumor characteristics, operative details,
postoperative outcomes, and prognosis.
Results For LADG, 35 patients were considered obese, and 106 patients were non-obese. For ODG, 25 patients were considered obese,
and 82 patients were non-obese. Mean operative times in each procedure were significantly longer for the obese group than
for the non-obese group (ODG: 241.4 min vs. 199.5 min, p < 0.0001; LADG: 279.6 min vs. 255.3 min, p = 0.03). Blood loss was significantly higher for the obese group than for the non-obese group in ODG (300 ml vs. 400 ml, p = 0.024), but no significant differences were observed between obese and non-obese groups for LADG. Incidence of major postoperative
complications, number of retrieved lymph nodes, and disease-free survival rates were similar in obese and non-obese groups
for each procedure.
Conclusions Our analysis revealed that LADG can be safely performed in obese patients, with complication rates and operation outcomes
similar to those for non-obese patients. 相似文献
17.
Yoon HM Yang HK Lee HJ Park do J Kim HH Lee KU Ahn HS Jo JJ 《Surgical endoscopy》2011,25(6):1761-1765
Background
Several studies have suggested that carbon dioxide (CO2) pneumoperitoneum may have an effect on liver function. This study aimed to compare liver function after laparoscopically assisted distal gastrectomy (LADG) and open distal gastrectomy (ODG) for patients with liver disease.Methods
Between January 2006 and December 2007, the study enrolled 50 patients with EGC and liver disease including 18 liver cirrhosis patients, 3 fatty liver patients (n?=?3), and 29 healthy hepatitis B or C virus carriers. Albumin, total bilirubin, alkaline phosphatase, aspartate aminotransferase, and alanine aminotransferase levels as well as the volume of drainage in the LADG (n?=?18) and ODG (n?=?32) groups were determined to assess liver function.Results
The albumin level on postoperative day 7 was significantly higher in the LADG group (3.5?mg/dl) than in the ODG group (3.1?mg/dl; p?=?0.042), and the volume of drainage on postoperative day 2 was significantly lower in the LADG group (154.3?ml) than in the ODG group (403.1?ml; p?=?0.013). Diuretics were needed by three patients (16.7%) in the LADG group and six patients (18.7%) in the ODG group for control of ascites (p?=?0.587). For the patients with liver cirrhosis, none of the parameters between the two groups were significantly different.Conclusion
For gastric cancer patients with chronic liver disease, LADG can be considered a safe surgical procedure showing surgical outcomes comparable with those for ODG. 相似文献18.
目的:对比开腹与腹腔镜辅助远端胃癌根治术的手术效果、围手术期恢复情况及预后,探讨腹腔镜辅助远端胃癌根治术的可行性及安全性。方法:选取2011年1月至2012年12月行远端胃癌根治术(远端胃切除+D2淋巴结清扫)的216例患者其分为两组,观察组行腹腔镜手术(n=104),対照组行开腹手术(n=112)。対比研究两组间的肿瘤生物学行为、手术时间、术中出血、术中淋巴结切除数量、术后胃肠道功能恢复时间、术后下床活动时间、术后并发症、住院时间、3年无瘤生存率。结果:两组在肿瘤生物学行为方面差异无统计学意义。观察组手术时间明显长于对照组(P0.05),术中出血量、淋巴结清扫数量、术后排气时间、术后下床活动时间及住院时间均优于对照组,差异有统计学意义(P0.05);术后并发症按Clavien-Dindo法分级并进行対比两组间差异无统计学意义(P0.05);3年无瘤生存率两组差异无统计学意义(P0.05)。结论:腹腔镜辅助下远端胃癌根治术是安全、可行的,与传统手术相比,在术中出血量、淋巴结清扫数量、术后恢复方面具有明显优势。 相似文献
19.
目的 评价腹腔镜辅助下胃癌D2根治性远端胃大部分切除术的安全性与有效性.方法 检索Pubmed、Medline、EMBASE和中国生物医学数据库(CBM)2001年1月至2010年2月间发表的D2根治性远端胃大部分切除术治疗胃癌的对照试验研究,用Revman 5.0统计软件进行分析.结果 共纳入7个对照试验,其中1项研究为随机对照试验,6项为非随机对照研究.腹腔镜辅助远端胃大部分切除组(LADG)与开腹远端胃大部切除术(ODG组)相比,术中出血量少[加权均数差(WMD)=-132.04,95% CI:-207.32~-56.77],术后第1次排气时间早(WMD=-0.82,95% CI:-1.20~-0.45),术后并发症发生率低[相对危险度(OR)=0.45,95%CI:0.26~0.78],术后住院时间短(WMD=-3.63,95%CI:-4.19~-3.07),清扫的淋巴结数目多(WMD=1.93,95%CI:0.36~3.50) 但术后复发率、转移率和近期(3年内)生存率差异无统计学意义(P>0.05).结论 腹腔镜辅助下胃癌D2根治性远端胃大部分切除术的短期效果优于开腹手术. 相似文献
20.
Shuji Takiguchi Yoshiyuki Fujiwara Makoto Yamasaki Hiroshi Miyata Kiyokazu Nakajima Mitsugu Sekimoto Masaki Mori Yuichiro Doki 《World journal of surgery》2013,37(10):2379-2386