进展期远端胃癌腹腔镜与开腹根治术的对照研究

目的探讨腹腔镜远端胃癌根治术治疗进展期远端胃癌的可行性、安全性及近期疗效．方法回顾性分析2007年1月至2008年6月间135例接受外科手术的远端胃癌患者的临床资料．其中腹腔镜远端胃癌根治术66例．开腹远端胃癌根治术69例。结果腹腔镜组与开腹组患者年龄、性别和TNM分期的差异均无统计学意义（均P〉0．05）。腹腔镜组均在腹腔镜下成功完成根治性胃切除手术,无中转开腹和手术死亡。与开腹组比较,腹腔镜组患者手术时间更长[（266．1±55．1）min比（223．8±26．8）min];但术中出血量更少[（131．9±88．7）ml比（342．3±178．7）ml],术后肠道恢复功能更快[（3．18±1．22）d比（4．50±1．59）d],术后住院时间更短[（9．20±3．39）d比（11．35±4．61）d];差异均有统计学意义（均P〈0．01）。两组清扫淋巴结数目[（25．81±12．53）枚比（27．47±10．28）枚]和术后并发症发生率[6．1％（4／66）比15．94％（11／69）1的差异均无统计学意义（均P〉0．05）。术后随访1～19个月．两组均未见肿瘤复发或肿瘤相关死亡病例。结论腹腔镜远端胃癌根治术是治疗进展期远端胃癌安全、可行、微创、有效的方法。     

腹腔镜辅助下远端胃癌根治术与开放手术比较的临床研究

目的比较腹腔镜辅助下远端早、中期胃癌根治手术与传统开腹手术的疗效。方法回顾性分析我院2004年6月～2006年8月行腹腔镜辅助下根治性远端早、中期胃癌根治术19例及常规开腹远端早、中期胃癌根治术51例的临床资料。结果腹腔镜组19例均成功行腹腔镜辅助手术。腹腔镜手术和开放手术的平均时间分别为（194．5±23．21）min和（177．8±19．78）min,出血量分别为（182．4±40．21）ml和（346．8±33．98）ml,清扫淋巴结数量分别为（18．4±2．3）枚和（17．7±2．6）枚,术后肛门排气时间分别为第（4．31±1．28）d和第（4．89±1．62）d,平均住院时间分别为（14．3±2．5）d和（17．6±3．7）d,术后第1d平均白细胞计数分别为（8．79±3．54）×10^9／L和（10．43±2．78）×10^（／L。所有手术均无吻合口漏及术后死亡病例。结论腹腔镜辅助下胃癌根治术较传统开腹手术耗时长,但能达到胃癌标准根治术的淋巴结清扫范围,且具有出血少、住院时间短等优点。     

Long-term quality of life after laparoscopy-assisted distal gastrectomy for gastric cancer

Background Laparoscopy-assisted distal gastrectomy (LAG) is gaining acceptance for treating early gastric cancer. However, the long-term quality of life after LAG for gastric cancer is unknown. This study compared the long-term quality of life after LAG versus open distal gastrectomy (ODG) for early gastric cancer. Method This study included 53 patients who underwent LAG and 37 patients who underwent ODG for treatment of early gastric cancer. Quality of life was evaluated on the basis of a 22-item questionnaire that addressed food tolerance and mental and physical conditions, scored on a scale of 1–3. Results The mean follow-up periods after LAG and ODG were 99.3 and 97.0 months, respectively. Although the majority of patients who had undergone LAG were consuming a normal diet and had weight loss of less than 5 kg, all 22 items and the total score of the LAG group were comparable to those of the ODG group. However, the incidence of postoperative intestinal obstruction was significantly lower in the LAG group than in the ODG group (1% vs. 13%, p < 0.05). Conclusions LAG is equivalent to ODG with respect to long-term quality of life and is associated with a reduced incidence of postoperative intestinal obstruction. This work was supported in part by a Grant-in-Aid for Scientific Research (No. 15390401) from the Japanese Ministry of Education, Science, and Culture     

Laparoscopic-assisted distal gastrectomy versus open distal gastrectomy for advanced gastric cancer

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.     

早期胃癌腹腔镜与开腹根治术的对照研究

目的评价腹腔镜胃癌根治术治疗早期胃癌的可行性、安全性、肿瘤根治性以及术后近期疗效.方法回顾性分析2004年8月至2007年8月间68例接受外科手术的早期胃癌的临床和手术资料,其中腹腔镜胃癌根治术31例,开腹胃癌根治术37例;并比较两组的手术时间、术中出血、术后胃肠道恢复、术后住院天数、术后并发症、术后病理及随访等结果.结果全部31例早期胃癌均在腹腔镜下完成胃切除和淋巴结清扫,无中转开腹,其中远端胃大部切除术28例,近端胃大部切除术2例,全胃切除术1例;D1 α式淋巴结清扫16例、D1 β式淋巴结清扫2例,D2淋巴结清扫13例.腹腔镜胃癌根治术的平均手术时间为194.8±50.8 min,与开腹组无显著性差异;术中出血量(138.7±157.3)ml,显著低于开腹组(P＜0.05).腹腔镜手术后肠道恢复功能时间1.8(1～4)d,显著少于开腹组(P＜0.01).腹腔镜组术后并发症发生率为3.2%,与开腹组无显著性差异(P＞0.05).腹腔镜组清扫淋巴结数(9.6±4.4)枚,测量胃近端和远端正常切缘(3.8±1.6)cm及(3.5±1.3)cm,与开腹组比较无显著性差异.术后中位随访15(2～35)个月,腹腔镜组无肿瘤复发或者死亡,开腹组一例因腹膜复发而死亡.结论腹腔镜胃癌根治术是治疗早期胃癌安全、可行、微创、有效的方法.     

开腹与腹腔镜辅助远端胃癌根治术的临床对比研究

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。     

Comparative study of laparoscopy-assisted distal gastrectomy and open distal gastrectomy

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.     

Comparison of long-term outcomes of laparoscopy-assisted and open distal gastrectomy for early gastric cancer

Backgroud  Application of laparoscopy-assisted distal gastrectomy (LADG) for early gastric cancer (EGC) is still controversial because of scant evidence of long-term safety and feasibility. We evaluated the long-term outcome of LADG compared with conventional open distal gastrectomy (ODG) for EGC. Methods  Between March 1999 and July 2006, 106 patients underwent LADG and 105 patients underwent ODG for EGC. Clinicopathologic characteristics, postoperative outcomes, hospital course, postoperative morbidity, postoperative mortality, and long-term outcomes, including cancer recurrence and survival, were retrospectively compared between the two groups. Survival of all patients was confirmed with 55-month median follow-up. Results  Postoperative recovery was significantly faster in the LADG group; passing flatus occurred earlier, starting a liquid diet began sooner, and postoperative hospital stay was shorter (p < 0.05). Mean operation time was significantly longer in the LADG group. Postoperative complications in the LADG group occurred less frequently compared with in the ODG group (4.7% versus 13.3%, p = 0.046). Tumor recurrence occurred in two cases (0.9%) and death related to recurrence occurred in only one patient (0.5%). Overall 5-year survival rate (5-YSR) of all patients was 95.5%, while disease-specific 5-YSR was 98.8%. There was no significant difference in survival rates between the two groups; overall 5-YSR of the ODG and LADG groups was 94.9% and 95.9%, respectively. Conclusions  Our data suggest that LADG for EGC is feasible and safe. We expect the results of the present study to be confirmed by prospective randomized analysis. Dr. Lee and Dr. Yom contributed equally to the research and writing of the paper.     

Gastrointestinal recovery and outcome after laparoscopy-assisted versus conventional open distal gastrectomy for early gastric cancer

Laparoscopy-assisted gastrectomy has been increasingly reported as the treatment of choice for early gastric cancer. However, there is little information regarding the benefits of laparoscopy-assisted distal gastrectomy (LADG). LADG and conventional open distal gastrectomy (DG) for early gastric cancer were compared in terms of operative outcome, recovery of bowel function, complications, and changes in body weight. Thirty-four patients underwent LADG for early gastric cancer. These patients were compared with 31 patients who underwent DG during the same period. For estimating gastrointestinal motility recovery, 20 radiopaque markers were inserted into the duodenum during surgery, and abdominal X-rays were taken daily until all markers were seen in the ascending colon. Age, gender, and histologic differentiation of the lesions were matched. The LADG group required a significantly longer operative time and the dissection of fewer lymph nodes. Postoperative hospital stay and the occurrence of postoperative complications (ileus) were significantly shorter and less frequent in the LADG group. The LADG group showed a more rapid recovery of gastrointestinal motor function compared with the DG group during the early postoperative period. Body weight 24 months after LADG was about 100% of pre-illness weight, but no further weight change was encountered in the DG group. For selected patients with early gastric cancer, LADG with lymphadenectomy can provide a rapid recovery and good quality of life without compromising the cure rate.     

进展期胃癌腹腔镜D2根治术临床效果观察

目的分析进展期胃癌腹腔镜D2根治术的效果。方法将70例进展期胃癌患者随机分观察组和对照组,各35例。观察组给予腹腔镜下D2根治术治疗,对照组给予开腹D2根治术治疗。观察两组的临床效果。结果观察组的手术时间、出血量、胃肠功能恢复时间及住院时间均明显少于对照组,两组比较差异无统计学意义(P0.05)。而两组的淋巴结清扫数比较,差异无统计学意义(P0.05)。观察组出现胸腔积液1例(2.86%),未出现死亡病例。对照组出现并发症7例(20.00%),无死亡病例,两组的并发症发生率比较,差异有统计学意义(P0.05)。结论进展期胃癌腹腔镜D2根治术手术住院时间短,术中出血量少,术后并发症少,临床效果显著。     

Efficacy of laparoscopy-assisted distal gastrectomy for gastric cancer in the elderly

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.     

Short-term efficacy of laparoscopy-assisted vs open radical gastrectomy in gastric cancer

AIM:To investigate the short-term benefits of laparoscopic radical gastrectomy(LARG)and open radical gastrectomy(ORG)in patients with gastric cancer.METHODS:A total of 400 patients with gastric cancer aged≤65 years who were treated at General Hospital of Lanzhou Military Region were enrolled.Among these,200 patients underwent LARG between October2008 and August 2012(LARG group);and 200 patients underwent ORG between March 2000 and September2008(ORG group).The short-term therapeutic benefits between the two groups were analyzed.RESULTS:The LARG procedure offered significantly better benefits to the patients compared to the ORG procedure,including less intraoperative blood loss(103.1±19.5 mL vs 163.0±32.9 mL,P0.0001),shorter postoperative hospital stay(6.8±1.2 d vs 9.5±1.6 d,P0.0001),less frequent occurrence of postoperative complications(6.5%vs 13.5%,P=0.02),shorter time to mobilization(1.0±0.3 vs 3.3±0.4 d,P0.0001),shorter time to bowel opening(3.3±0.7 d vs 4.5±0.7 d,P0.0001),and shorter time to normal diet(3.0±0.4 vs d 3.8±0.5 d,P0.0001).However,LARG required a longer time to complete than the ORG procedure(192.3±20.9 min vs 180.0±26.9 min,P0.0001).CONCLUSION:Compared to ORG,LARG is safer,more effective,and less invasive for treating gastric cancer,with better short-term efficacy.     

Long-term outcomes after laparoscopy-assisted gastrectomy for advanced gastric cancer: a large-scale multicenter retrospective study

Background

Recently, the number of laparoscopic procedures for gastric cancer has increased rapidly. Laparoscopic surgery is reported to have many advantages over open gastrectomy with oncologic safety in early gastric cancer. However, there were few reports on long-term outcomes of laparoscopy-assisted gastrectomy (LAG) for advanced gastric cancer (AGC). The aim of this study was to investigate long-term survival outcomes after LAG for AGC.

Methods

The data of 1,485 patients who underwent LAG between April 1998 and December 2005 by ten surgeons at ten hospitals were collected retrospectively. Among them, 239 patients who were diagnosed with AGC on final pathologic examination were enrolled in the present study to investigate long-term clinical outcomes.

Results

The ratio of male to female patients was 151:88 and the mean age was 57.1?years. One hundred ninety-three subtotal gastrectomies, 41 total gastrectomies, and 5 proximal gastrectomies were performed. D1?+?α, D1?+?β, and D2 lymph node dissections were performed for 14, 62, and 163 cases, respectively. The median follow-up period was 55.4?months. The overall 5-year survival rate of the 239 AGC patients was 78.8% and the disease-specific 5-year survival rate was 85.6%. The 5-year survival rates of the TNM staging system’s (7th ed.) stages were 90.5% (stage Ib, n?=?86), 86.4% (stage IIa, n?=?53), 78.3% (stage IIb, n?=?44), 52.8% (stage IIIa, n?=?24), 52.9% (stage IIIb, n?=?24), and 37.5% (stage IIIc, n?=?8) (p?Conclusion The long-term survival outcome rates of LAG for AGC in the present study were comparable to those previously reported for open gastrectomy. Based on the present results, a well-designed phase III trial comparing LAG and open gastrectomy for AGC will be needed to affirm the validity of LAG for AGC.     

腹腔镜辅助胃远端癌淋巴结清扫术近期疗效

目的探讨腹腔镜辅助胃远端癌D2淋巴结清扫术的可行性及近期疗效。方法2007年1月至2008年12月,对241例胃远端癌患者施行D2淋巴结清扫术。其中腹腔镜辅助远端胃大部切除术（LADG组）93例,常规开腹远端胃大部切除术（ODG组）148例。比较两组患者的淋巴结清扫数及术中、术后恢复情况、并发症发生率和住院死亡率。结果LADG组和ODG组患者淋巴结清扫数分别为（27．5±9．1）枚和（27．3±8．5）枚,两组差异无统计学意义（P〉0．05）。按肿瘤浸润深度进行分层分析,T1、T2、T3期患者两组平均清扫淋巴结数差异均无统计学意义（P〉0．05）。LADG组手术时间显著长于ODG组,但术中出血量、输血例数、术后首次下床时间、肛门排气时间、进流质时间、住院时间和手术并发症发生率均显著少于ODG组,两者差异有统计学意义（P〈0．05）。结论腹腔镜辅助胃远端癌D2淋巴结清扫术在淋巴结清扫方面能达到与开腹手术相同的效果,且具有安全、术后恢复快和并发症少等优点。     

远端进展期胃癌腹腔镜辅助与开腹根治术的远期疗效比较

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。