Clinical Research Of Laparoscopic Gastrectomy For Advanced Cancer

Objective:To research the laparoscopic gastrectomy for advanced cancer during comparing with open gastrectomy.Method:From March 2010 to December 2010,63 patients with advanced gastric cancer underwent laparoscopic gastrectomy in our medical center (3 patients convert to open during surgery) and the other 60 advanced gastric cancer patients underwent open gastrectomy at the same period.For comparing the two groups, the parameters observed including:operation related index, recovery index after surgery, complications related to the surgery, pathologic conditions. All patients were followed up for 3-12 months. Data was analysed by the SAS 8.0 satistical software.Results:The mean operation time of the laparoscope group was 250mins, while the open group was 156mins, the blood loss during surgery were 120ml and 240ml, the length of incision were 6.04±0.52cm and 18.36±1.81cm, respectively; the time of intestinal function recovery, time of intaking food, hospital stay in the lap group were shorter than in the open group, the number of usage of self control pain killer for the lap group was less; the post-operational complications including pleural effusion, incision fat liquefaction, blood of the stoma, gastroplegia, the rate of the laparoscopic group was 11.67 (7/60),while the OG was 15.00%(9/60); during the 3-12 months followed up, no recurrence, metastasis to the incision or other organ, death cases were found, while no trocar metastasis was found in the lap groups; the mean clear distal and proximal margin from rumor was not significantly different in the two groups. The number of lymph nodes in the lap group was more than in the open group significantly. Most pTNM stage of the patients was on the IB-IIIC stage. The laparoscope learning curve was observed when 20 patients were underwent the lap surgery.Conclusion:The standardized laparoscopic gasterctomy for advanced gastric cancer is safe and feasible, less complications and minimally invasive techinique, and its short-term outcome is favorable. It's valuable of the palliative treatment for the late advanced gastric cancer. According to the experiences of our center:1) the indication is larger and individualized therapy was prompt in different medical center; 2) better clinical effects are observed when standardization of the lap surgery; 3) laparoscopic assisted gastrectomy with D2 lymph node dissection is popular in China, the SLN research can benefit the lymph node dissection, the TLG and D3 surgery are also valuable to research; 4) RCT research of the functional surgery as preservation of vagus nerveis is needed to be observed.