局部进展期近端胃癌新辅助化疗后腹腔镜与开腹手术安全性与近期疗效研究

  目的  研究局部进展期近端胃癌新辅助化疗后腹腔镜与开腹手术在安全性与近期疗效方面的差异。  方法  回顾性分析2018年1月至2020年1月徐州医科大学附属医院收治的74例局部进展期近端胃癌患者的临床资料。通过倾向性评分法进行1∶1匹配将66例患者纳入研究。新辅助化疗后，行腹腔镜手术患者34例，行开腹手术患者32例，比较两组患者的手术时间、术中出血量、淋巴结清扫数目、进食时间、术后住院天数及并发症，随访术后18个月患者的总生存期（overall survival，OS ）及无病生存期（disease- free survival，DFS）。  结果  两组数据对比发现，腹腔镜手术在术中出血量、术后住院时间、排气时间及进食时间上更具优势，在手术时间、清扫淋巴结数目方面逊于开腹手术，差异有统计学意义（P<0.05）；两组在术后并发症、18个月OS及DFS方面，差异无统计学意义（P>0.05）。  结论  腹腔镜手术能减少术中出血量及缩短术后恢复时间，但在手术时间及淋巴结清扫数目上逊于开腹手术；腔镜手术的安全性及近期疗效值得肯定，长期疗效值得进一步研究。 

Comparison of safety and short-term efficacy between laparoscopy and laparotomy for locally advanced proximal gastric cancer after neoadjuvant chemotherapy

  Objectives  To compare the safety and short-term curative effect of laparoscopic proximal gastrectomy (LPG) versus open proximal gastrectomy (OPG) in treating locally advanced proximal gastric cancer after neoadjuvant chemotherapy (NACT) and to investigate the rationality of surgical selection.   Methods  The clinical data of 74 patients admitted for locally advanced proximal gastric cancer at Affiliated Hospital of Xuzhou Medical University between January 2018 and January 2020 were retrospectively analyzed. Sixty-six patients were enrolled after 1:1 matching through the propensity scoring method. All received neoadjuvant chemotherapy preoperatively. Thirty-four patients were assigned into the laparoscopic group and 32 patients into the open group. For the safety of the two groups during the operation and intraoperative postoperative related-index analysis, specifically for the patients with some clinical indicators, such as operation time, amount of intraoperative blood loss, dissected lymph node numbe, postoperative intestinal function recovery time, postoperative hospitalization time, and postoperative complications, the 18-month overall survival (OS) and disease-free survival (DFS) rates.   Results  Laparoscopic surgery has more advantages with respect to the amount of intraoperative blood loss, postoperative hospital stay, exhaust time, and feeding time (P<0.05). However, the operation time was shorter and number of dissected lymph nodes was more in the open group than that in the laparoscopic group. Postoperative complications and the rate of the 18-month OS and DFS were not significantly different (P>0.05).   Conclusions  Laparoscopic surgery can reduce intraoperative blood loss and postoperative recovery time, but it is inferior to open surgery in operative time and number of lymph nodes dissected. The safety and short-term efficacy of laparoscopic surgery deserve affirmation and long-term efficacy should be further studied.