Totally laparoscopic versus open gastrectomy for advanced gastric cancer : a matched retrospective cohort study

針對晚期胃癌的全腹腔鏡相對開腹胃切除術 : 一項匹配的回溯性隊列研究

Research output: Journal Publications and Reviews (RGC: 21, 22, 62)21_Publication in refereed journalpeer-review

5 Scopus Citations
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Original languageEnglish
Pages (from-to)30-37
Journal / PublicationHong Kong medical journal = Xianggang yi xue za zhi
Volume25
Issue number1
Online published18 Jan 2019
Publication statusPublished - Feb 2019

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Abstract

Introduction: Laparoscopic gastrectomy revolutionised the management of gastric cancer, yet its oncologic equivalency and safety in treating advanced gastric cancer (especially that in smaller centres) has remained controversial because of the extensive lymphadenectomy and learning curve involved. This study aimed to compare outcomes following laparoscopic versus open gastrectomy for advanced gastric cancer at a regional institution in Hong Kong. Methods: Fifty-four patients who underwent laparoscopic gastrectomy from January 2009 to March 2017 were compared with 167 patients who underwent open gastrectomy during the same period. All had clinical T2 to T4 lesions and underwent curative-intent surgery. The two groups were matched for age, sex, American Society of Anaesthesiologists class, tumour location, morphology, and clinical stage. The endpoints were perioperative and long-term outcomes including survival and recurrence. Results: All patients had advanced gastric adenocarcinoma and received D2 lymph node dissection. No between-group differences were demonstrated in overall complications, unplanned readmission or reoperation within 30 days, 30-day mortality, margin clearance, rate of adjuvant therapy, or overall survival. The laparoscopic approach was associated with less blood loss (150 vs 275 mL, P=0.018), shorter operating time (321 vs 365 min, P=0.003), shorter postoperative length of stay (9 vs 11 days, P=0.011), fewer minor complications (13% vs 40%, P<0.001), retrieval of more lymph nodes (37 vs 26, P<0.001), and less disease recurrence (9% vs 28%, P=0.005). Conclusion: Laparoscopic gastrectomy offers a safe and effective therapeutic option and is superior in terms of operative morbidity and potentially superior in terms of oncological outcomes compared with open surgery for advanced, surgically resectable gastric cancer, even in a small regional surgical department.
引言:腹腔鏡胃切除術徹底改變胃癌的治療方法,但由於其大規模的淋巴結切除術和學習曲線,其治療晚期胃癌的腫瘤學等效性和安全性一直存在爭議(規模較細的醫療中心尤以為甚)。本研究旨在比較本港一所地區醫院腹腔鏡與開腹胃切除術治療晚期胃癌的結果。方法:將2009年1月至2017年3月接受腹腔鏡胃切除術的54例患者與同期接受開腹胃切除術的167例患者進行比較。所有患者均有臨床T2至T4病變並進行治癒性手術。兩組在年齡、性別、美國麻醉醫師學會等級、腫瘤位置、形態和臨床分期方面均相匹配。研究的終點是圍手術期和長期結果,包括生存和復發數據。結果:所有患者均患有晚期胃腺癌並接受D2淋巴結切除術。總體併發症、30天內非計劃再入院或再次手術、30天死亡率、邊緣清除率、輔助治療率或總體生存率均未發現組間差異。與開腹胃切除術比較,腹腔鏡手術的失血量較少(150比275毫升,P=0.018)、手術時間較短(321比365分鐘,P=0.003)、術後住院時間較短(9比11天,P=0.011)、較少輕微併發症(13%比40%,P<0.001)、淋巴結擷取較多(37比26,P<0.001),以及疾病復發率較低(9%比28%,P=0.005)。結論:對於治療晚期但可手術切除的胃癌,即使在規模較小的地區醫院外科部門進行腹腔鏡胃切除術也是安全有效的手術選擇;與開腹手術相比,前者的手術發病率具有優勢,也可能在腫瘤學結果方面較為優越。

Research Area(s)

  • Gastrectomy, Laparoscopy, Laparotomy, Morbidity, Stomach neoplasms, Survival

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