The operative indications for proximal gastrectomy in patients with gastric cancer in the upper third of the stomach

While proximal gastrectomy is often performed for early gastric cancer in Japan, it remains unclear whether or not proximal gastrectomy should be performed for advanced gastric cancer. This study was designed to determine the operative indications for proximal gastrectomy in patients with gastric cancer in the upper third of the stomach. A total of 1691 patients with gastric cancer were reviewed retrospectively from hospital records during the period from 1969 to 1994, and the clinicopathologic characteristics of 82 patients who underwent proximal gastrectomy were compared with those of 150 patients who underwent total gastrectomy. Lymph node metastasis along the lower part of the stomach was observed in gastric cancers which had invaded beyond the muscularis propria of the stomach, but not in those confined to the muscularis propria. Three patients with gastric cancer that had invaded beyond the muscularis propria and metastasized to nodes along the lower part of the stomach were cured by total gastrectomy. However, there was no difference in the postoperative survival rates of the patients treated with proximal gastrectomy and those treated with total gastrectomy, irrespective of tumor stage and depth of invasion. Thus, proximal gastrectomy should be performed for gastric cancer when the depth of invasion is confined to the muscularis propria of the stomach.     

腹腔镜与开放手术行胃癌根治术临床疗效分析

目的 探讨腹腔镜辅助下行胃癌根治术的安全性及可行性.方法 回顾性分析我科2011年1月至2012年12月同期收治的胃癌需手术治疗患者107例临床资料,分为腹腔镜组（50例）和开腹组（57例）,对比分析两组手术患者手术及术后情况.结果 两组患者均没有死亡病例,手术时间腹腔镜组为（293.24±54.49） min,开腹组为（217.34-38.65） min（P ＜0.01）,与开腹组比较,腹腔镜组术中出血量、术后胃肠功能恢复时间、下床活动时间及住院时间的差异有统计学意义（P＜0.05）,两组患者术后淋巴结清除个数分别为21.73枚和23.15枚,术后早期并发症在两组无明显区别.结论 腹腔镜胃癌D2根治术是安全可行的,与开腹手术相近根治效果,且具有术后恢复迅速、创伤小等优点.     

Evaluation of extended lymph node dissection for gastric cancer

A total of 587 cases with gastric cancer was reviewed. Particular emphasis was placed on the comparative studies on the stages of stomach cancer and end-results of the R₂ (with a conventional lymph node dissection) and the R₃-resections (with an extended lymph node dissection). R₃-resections were found to be generally associated with higher 5-year survival rates than R₂-resections. Especially for the positive lymph node cases not having a marked serosal invasion, the 5-year survival rate was considerably higher with R₃-resections than with R₂-resections (55.3 percent versus 21.5 percent). Although the differences were not significant statistically, it has been suggested from these results that the end-results might be improved more effectively by performing R₃ resection for cases without a marked serosal invasion.     

腹腔镜辅助下胃癌根治切除术治疗进展期胃癌的临床效果分析

目的：分析腹腔镜辅助下胃癌根治切除术治疗进展期胃癌的疗效。方法中国医学科学院肿瘤医院2009年1月至6月按纳入标准收治的进展期胃癌患者164例,根据手术方式分为实验组（腹腔镜组）和对照组（开腹组）,其中实验组79例,对照组85例。实验组除使用腹腔镜辅助下胃癌根治切除术外,其他治疗同对照组。比较术中各项指标、术后病理学结果及恢复状况、并发症、5年生存率。结果实验组临床一般情况恢复明显好于对照组,差异有统计学意义（P＜0．05）。两组严重并发症发生率差异有统计学意义（P＜0．05）。两组5年生存率差异无统计学意义（P＞0．05）。结论腹腔镜下辅助胃癌根治切除术治疗进展期胃癌是安全可行的,能获得与开腹手术相当的治疗效果,且术后恢复有明显优势。     

腹腔镜下早期胃癌节段切除术

目的探讨胃节段切除在分化型早期胃癌手术中的可行性。方法严格挑选2013年8月至2015年6月间4例中段早期胃癌病人,实施腹腔镜下胃节段切除并D1+或D2淋巴结清扫。观察淋巴结清扫数目、术后并发症等情况。结果在清扫小弯侧淋巴结过程中没有保留迷走神经。远端切缘距离幽门4 cm以上,平均淋巴结获取数目为18.5枚。在术后1年内均存在胃排空缓慢的症状和影像学征像,1年后得到缓解。结论经腹腔镜行早期胃癌节段切除在技术上安全可行,是否保留迷走神经有待于进一步的观察。     

腹腔镜胃癌根治术治疗进展期胃癌的现状与临床研究

不同于日、韩等国家,我国胃癌病例大多以进展期胃癌为主.手术根治作为胃癌的主要治疗手段,近年来取得了很大发展,特别是腹腔镜胃癌根治术的发展.然而针对于腹腔镜胃癌根治术应用于进展期胃癌治疗的诸多方面,在国内外仍存在较大争议,特别是在手术适应证、具体术式以及重建方法选择、镜下完成D2淋巴结清扫以及术后的近期疗效与远期肿瘤学疗...     

Proximal subtotal gastrectomy for the treatment of carcinoma of the upper third of the stomach: Its indications based on lymph node metastasis and perigastric lymphatic flow

To clarify the indications for a proximal subtotal gastrectomy in the treatment of carcinoma in the upper third of the stomach based on lymph node metastases, 1055 patients in whom either a D₂ or greater lymph node removal was performed were reviewed. In the patients in which the lesion was confined to the upper stomach and did not invade beyond the muscularis propria of the stomach wall, no metastases to either the lymph nodes above and below the pylorus or the lymph nodes along the greater curvature were observed. A lymphatic flow study revealed a minimal flow to these nodes from the upper stomach in patients without lymph node metastasis, but in cases with lymph node metastases the lymphatic flow changed. The indications for a proximal subtotal gastrectomy for a carcinoma of upper third of the stomach therefore must fulfill the following two conditions: (1) The deepest layer of cancerous invasion does not extend beyond the muscularis propria of the stomach wall, and (2) No macroscopic evidence of lymph node metastasis can be detected during surgery.     

Subtotal gastrectomy for cancer located in the greater curvature of the middle stomach with prevention of the left gastric artery

BACKGROUND: A novel distal subtotal gastrectomy was performed in 5 patients with macroscopically node-positive gastric cancer located in the greater curvature of the middle stomach. In these patients, total gastrectomy or standard distal subtotal gastrectomy has been typically performed. In these typical gastrectomies, the hepatic and the coeliac branches of the vagi are removed en bloc with the left gastric artery and the whole of the lesser omentum because the lymphatics along the left gastric artery are in the lower stream-regions of lymph flow from the cancer and metastases exist potentially. METHODS: During novel distal subtotal gastrectomy the activated carbon method confirmed that the lymphatics along the ascending branch of the left gastric artery were not in the lower stream-region of lymph flow from the cancer. Then, we preserved the hepatic and coeliac branches of the vagi as well as the ascending branch of the left gastric artery and the upper part of the lesser omentum. The other arteries feeding the stomach were removed with the surrounding lymphatics. In novel distal subtotal gastrectomy the remnant stomach was fed only by the ascending branch of the left gastric artery, while in standard distal subtotal gastrectomy the remnant stomach was fed by the short gastric arteries. CONCLUSIONS: Although further examinations are necessary, novel distal subtotal gastrectomy may have superior merit such as good function of gallbladder because of the preservation of the vagal nerve system, compared with total gastrectomy or standard distal subtotal gastrectomy.     

腹腔镜辅助下进展期胃癌根治术的临床应用(附47例报告)

目的 研究腹腔镜在进展期胃癌中根治术能否满足胃癌手术切缘及D2淋巴结清扫的根治要求.方法 对47例行腹腔镜辅助下胃癌根治术的进展期胃癌患者的临床资料进行回顾性分析.结果 腹腔镜辅助下根治性近端胃大部切除术25例,根治性远端胃大部切除术11例,全胃根治术10例,1例中转开腹;手术时间(220±55)min,术中出血(150±87)ml.术后肛门排气时间、下床活动时间、术后住院时间分别为(5.1±0.5)d、(3.2±0.8)d、(9.0±1.5)d;腹腔镜辅助远端胃大部切除术11例,手术时间(284±37)min,术中出血(120±70)ml.术后肛门排气时间、下床活动时间、术后住院时间分别为(4.0±0.8)d、(3.2±1.5)d、(9.0±2.0)d.腹腔镜辅助全胃切除术10例,手术时间(330±50)min,术中出血(240±65)ml.术后肛门排气时间、下床活动时间、术后住院时间分别为(4.1±0.8)d、(3.2±0.8)d、(9.5±2.0)d.淋巴结清扫平均数(21.95±9.88)个,近端切缘与肿瘤距平均距离(6.41±2.13)cm;远端切缘与肿瘤平均距离(6.22±1.98)cm.无术中及术后并发症,近期疗效良好.结论 腹腔镜在进展期胃癌中根治术是安全可行的,能达到胃癌标准根治术(D2)的淋巴结清扫范围和肿瘤切缘,远期疗效有待进一步观察.     

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.     

胃上部癌行近端胃切除双通道吻合与全胃切除Roux-en-Y吻合临床疗效比较的meta分析

目的 采用meta分析方法比较胃上部癌患者行近端胃切除双通道吻合（PG-DT组）与全胃切除Roux-en-Y吻合术（TG-RY组）的临床疗效。方法 计算机检索Pubmed、Cochrane Library、Embase、中国知网,万方数据库、维普中文期刊网中关于胃上部癌行近端胃切除双通道吻合与全胃切除Roux-en-Y吻合研究报道。文献检索时限均从建库到2021年3月,由两名评价人员按照Cochrane系统评价手册5.1.0标准独立筛选文献,提取资料,分别应用Jadad量表及Newcastle-Ottawa Scale量表（NOS量表）对随机对照试验及观察性研究进行文献质量评价,使用RevMan 5.3软件分别对结局指标数据进行Meta分析,并对结果进行分析。结果 共纳入16项研究,均为病例对照试验,共纳入1346例患者,其中PG-DT组589例,TG-RY组757例。Meta分析结果显示：PG-DT组较TG-RY组围手术期并发症发生率更少（OR=0.56,95%CI:0.39～0.79,P<0.001）,但严重并发症（OR=0.47,95%CI:0.2～1.08,P=0.08）...     

Laparoscopy-assisted distal gastrectomy for early gastric cancer

Background Laparoscopy-assisted distal gastrectomy (LADG) is gaining wider acceptance for the treatment of early gastric cancer. However, firm evidence supporting its safety and usefulness is scant, and no study has compared the outcomes of various procedures for LADG. We examined the surgical outcomes of LADG performed using different methods for lymph node dissection. Methods Between September 1998 and January 2005, we performed LADG in 111 patients with early gastric cancer. In the 55 patients treated initially, group 2 lymph node dissection was performed through a small, 7-cm-long incision (minilaparotomy). In 43 of these patients, hand-assisted laparoscopic surgery (HALS) was done. In the 56 patients treated more recently, lymph node dissection was performed laparoscopically. In 31 of these patients, the celiac branches of the vagus nerve were preserved. Clinical outcomes of these procedures were compared. Results In the first 55 patients, HALS significantly shortened the operation time (277 vs 243 min, p < 0.05). In the latter 56 patients, LADG with preservation of the celiac branches of the vagus nerve was associated with a longer operation time (283 vs 228 min, p < 0.01) and higher blood loss (150 vs 92 g, p < 0.05) than with LADG without celiac branch preservation. There were no differences among the various operative procedures in postoperative course, including the length of the postoperative hospital stay or the rate of complications. Conclusions LADG is a safe and technically feasible procedure for the treatment of early gastric cancer. Laparoscopic lymph node dissection provided a good visual field and was easier to perform and required less time when the celiac branches of the vagus nerve were not preserved, with no negative effect on outcome.     

胃癌急性穿孔的外科治疗探讨（附17例报告）

目的　探讨胃癌穿孔的临床特点 ,围手术期处理及影响预后的因素。方法　总结我院17例胃癌急性穿孔病例 ,采用不同手术方式治疗。结果　围手术期死于中毒性休克并多脏器功能衰竭 2例。穿孔修补术、胃大部切除术、胃癌根治术平均生存期分别为 7.2 2个月、14.6个月、36 .4个月。结论　早期诊断及选择正确术式是降低病死率 ,提高生存质量的重要因素。     

进展期胃癌淋巴结清扫范围的研究进展

一个多世纪以来,胃癌的手术治疗存在诸多争议,尤其是进展期胃癌的淋巴结清扫范围是争论的焦点问题.本文就当前国内、外有关胃癌淋巴结清扫范围的研究报道及最新进展做一综述和分析.     

腹腔镜胃癌根治术合理应用及疗效评价

腹腔镜胃癌根治术已有近20年的历史,目前其在早期胃癌中应用已取得国内外的共识;而在进展期胃癌方面,尽管已经取得了较好的临床疗效,但仍需多中心的前瞻性随机对照研究结果来评价腹腔镜手术的优劣。外科医师只有严格选择合适病例,手术中严格遵循恶性肿瘤手术的根治原则,才能使腹腔镜胃癌根治术不仅具有微创优势,而且可以取得与开腹手术相当的远期疗效。     

Surgical technique of vagus nerve-preserving gastrectomy with D2 lymphadenectomy for gastric cancer

Preservation of the vagus nerve in curative gastrectomy for gastric cancer is important to maintain postoperative quality of life. We developed a vagus nerve-preserving gastrectomy with D2 dissection for patients with early gastric cancer and for selected patients with T2 cancer. Following lymph node dissection along the left gastric artery, the root of the left gastric artery was isolated and divided. The coeliac branch was followed retrogradely, and the posterior gastric branches were cut at their origins. The hepatic branch was also preserved. A total of 136 patients, including 27 cases of T2 cancer, underwent the vagus nerve-preserving gastric operation, and surgical anatomy of the coeliac branch was studied. In 110 cases, variations in the course of the coeliac branch were classified into three types according to its relationship with the left gastric artery: close to the artery (43 cases, 39.1%), intermediate (47 cases, 42.7%) and away from the artery (20 cases, 18.2%). In 115 patients who underwent vagus nerve-preserving distal gastrectomy (n = 93) or pylorus-preserving gastrectomy (n = 22), the postoperative bodyweight was 95.6 +/- 5.2% of the preoperative bodyweight, and the incidence of gallstone formation was 1.8% (2 of 113). A D2 dissection comparable with conventional D2 gastrectomy could be carried out using the vagus nerve-preserving technique. The coeliac branch could be preserved regardless of its anatomy, resulting in improvements in postoperative quality of life.     

近端早期胃癌患者的近端微创胃切除手术效果研究

目的探讨近端微创胃切除手术对于近端早期胃癌的效果。方法选取2007年1月至2012年1月在我院接受手术治疗的近端胃癌患者100例,其中50例接受近端微创胃切除术为试验组,50例接受胃全切除术为对照组,比较两组的手术情况、并发症、营养状况及胃食管反流Visik评分。结果在手术时间、淋巴清扫方式方面,两组相比差异不具有统计学意义(P0.05),而在手术失血量方面,近端胃切除组少于全胃切除组(P0.05)。两组在排气时间、进食时间差异不具有统计学意义(P0.05),但胃近端切除组在胃食管反流、贫血发生例数少于全胃切除组(P0.05),且全胃切除组术后6个月体重下降、术后血红蛋白水平、红细胞计数以及预后营养指数的下降比近端胃切除组明显并具有统计学意义(P0.05)。近端胃组Visik评分明显比全胃组高,差异具有统计学意义(P0.05)。结论近端微创胃切除术对于近端胃癌患者来说,术后的恢复良好,胃食管反流的发生率低,是一种可靠且安全的选择。     

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。     

腔腹镜下胃癌根治术在早期胃癌患者中的治疗效果分析

目的探讨腹腔镜下胃癌根治术治疗早期胃癌的临床效果。 方法回顾性分析2014年11月至2016年5月接收诊治的98例早期胃癌患者,开腹组和腹腔镜组各49例。运用统计学软件SPSS 16.0进行统计处理,两组临床疗效比较和术后并发症率用百分比(%)表示,χ²检验;手术相关指标应用( ±s)表示,采用t检验。P值小于0.05差异有统计学意义。 结果腹腔镜组患者术后1年时病死率和复发率为8.1%和22.5%,开腹组为10.2%和24.5%,经比较差异均无统计学意义(P>0.05)。腹腔镜组患者相关手术指标均显著优于开腹组,差异有统计学意义(P<0.05)。腹腔镜组患者并发症发生率2.0%(1/49)远远低于开腹组16.3%(8/49),差异有统计学意义(P<0.05)。 结论腹腔镜下胃癌根治术治疗早期胃癌患者的疗效理想,具有创伤小、恢复快以及并发症率低等特点,值得在临床治疗中广泛推广应用。