浆膜未受侵犯的进展期胃上部癌腹腔镜辅助与开腹全胃切除术的配对研究

目的 探讨腹腔镜辅助根治性全胃切除术在浆膜未受侵犯的进展期胃癌患者中运用的可行性及临床效果。方法 2009年1月至2011年12月，对388例浆膜未受侵犯的进展期胃癌患者施行胃癌D2根治术（其中行腹腔镜手术患者235例，行开腹手术患者153例）。以年龄、性别和浸润深度（pT2、pT3）为指标，用逐一配对法进行配对，最终116例患者纳入本研究（腹腔镜组58例和开腹组58例）。比较两组患者的术中、术后情况及术后生存曲线的差异。结果 两组患者一般临床病理资料的差异均无统计学意义（P>0.05）。腹腔镜组平均淋巴结清扫数目分别为（30.2?10.1）枚/例与开腹组的（28.0?8.1）枚相当（P>0.05）；且两组患者胃周各组别平均淋巴结清扫数目的差异均无统计学意义（P>0.05）。腹腔镜组手术时间、术中输血例数和首次下床活动时间与开腹组相似，而术中出血量、术后胃肠功能恢复时间、进食流质时间和术后住院时间等均少于开腹组。腹腔镜组术后并发症发生率及病死率分别为12.1%和0%，与开腹组的15.5%和1.7%比较，差异无统计学意义（P>0.05）。全组患者随访1～50个月，腹腔镜组与开腹组术后生存曲线的差异亦无统计学意义（P>0.05）。结论 腹腔镜辅助根治性全胃切除术治疗浆膜未受侵犯的进展期胃上部癌是安全、可行的，能够达到与开腹手术相当的根治效果。腹腔镜辅助根治性全胃切除术要成为治疗进展期胃癌患者的常规手术，需进行进一步大宗前瞻性随机对照研究。

A matched cohort study of laparoscopy-assisted and open total gastrectomy for advanced proximal gastric cancer without serosa invasionRunning title: Laparoscopic gastrectomy for advanced gastric cancer

Background: The feasibility and safety of laparoscopy-assisted total gastrectomy (LATG) with extended lymphadenectomy for advanced gastric cancer (AGC) has rarely been studied. The aim of this study is to compare the technical feasibility, safety, and oncologic efficacy of LATG with those of open total gastrectomy (OTG) for AGC without serosa invasion. METHODS: From Jan. 2009 to Dec. 2011, 235 patients underwent LATG, and 153 underwent OTG for AGC without serosa invasion. Age, gender, and depth of invasion (pT2 and pT3) were matched by propensity scoring, and 116 patients (58 LATG and 58 OTG) were selected for analysis. Their clinicopathologic characteristics, postoperative outcomes, and survival were compared. RESULTS: There was no significant difference in clinicopathologic characteristics between the two groups. The median of total LN number was 29 per patient, and the total number of retrieved lymph nodes was not different between the two groups (30.8 ± 10.2 vs 29.0 ±8.3). Regarding perioperative characteristics, the operation time, transfused patient number, and time to ground activities did not differ between the two groups; while the blood loss, time to ?rst ?atus, times of resume soft diet, and post-operative stay were significantly less in LATG group than those in OTG group (P<0.05). There was no statistically significant difference in postoperative complications (12.1% vs 15.5%) or postoperative mortality (0% vs 1.7%). There was no significant difference in the cumulative survival rate between the two groups, either. CONCLUSION: Our results suggest that LATG with D2 lymphadenectomy is a safe and feasible procedure for AGC without serosa invasion patients. A prospective, multicenter, randomized trial of LATG is needed to confirm the efficacy of this procedure.