Short-term Analysis Of Laparoscopy Assisted Total Gastrectomy Vs Open Total Gastrectomy In Upper Gastric Cancer

Background and objectiveAs one of the most common malignant tumors, gastric cancer is the first common cause of cancer death in China. The morbidity of upper gastric cancer has been on an increasing tendency recently, and its prognosis is worse than tumors in other locations. The surgical treatments of upper gastric cancer comprise total Gastrectomy and proximal Gastrectomy. Compared with subtotal Gastrectomy, total Gastrectomy bring heavier trauma to patients who have to experience a slow recovery and a bad quality of life. With the minimal invasiveness, the laparoscopy techniques have been applied by more and more surgeons in treatments of upper gastric cancer. However, the use of laparoscopy surgery in patients with upper gastric cancer who need total Gastrectomy remains controversial. Currently, related studies of laparoscopy assisted total Gastrectomy in gastric cancer have not been conducted enough in China. So in following study, we retrospectively analyze demographic factors、operation-related factors and postoperative factors between two groups who respectively received laparoscopy assisted total Gastrectomy and open total Gastrectomy in Department of Gastrointestinal Surgery in Shandong Provincial Hospital from December 2013 to December 2014 as a result of the diagnosis of upper gastric cancer, by which we can evaluate the safety, feasibility, short-term efficacy as well as disadvantages of laparoscopy assisted total Gastrectomy in gastric cancer.MethodsPatients:We collected 127 patients with upper gastric cancer who received total Gastrectomy in Department of Gastrointestinal Surgery in Shandong Provincial Hospital from December 2014 to December 2015. Patient selection criteria:(1)less than 75 years; (2)without seriously disease of main organs; (3)definite upper tumor locations before operation, lymph nodes metastasis limited to D1 or D2, no distant and implantation metastasis during operation. Patient exclusion criteria:(1) treatment of chemotherapy or radiotherapy before operation; (2) total Gastrectomy with splenectomy; (3)conversion to OTG during operation; (4)thoraico-abdominal operation.Surgical technique:Referring to Japanese Gastric Cancer Association treatment Guideline of 2013, all parents received total Gastrectomy and D2 removal. Removing of lymph nodes and cutting of duodenum in LATG group were conducted by laparoscopy, then cutting of esophagus、visceration of specimen and reconstruction of digestive tract were conducted via incision. Operations of the OTG group were conducted conventionally.Measurement(1) General statistics:sex, age, BMI, comorbidity, tumor bleeding.(2) Operation outcome:operation time, length of incision, intraoperative blood loss, blood transplantation.(3) Postoperative and pathological outcome:time to bowel opening, time to liquid diet, postoperative complications, re-operation, postoperative mortality, total hospital day, re-hospitalization in thirty days after discharge, NO. of lymph nodes removed, positive lymph nodes, depth of invasion, TNM stage.StatisticAll the data were statistically analyzed by SPSS 20.0, and significance was defined as P<0.05.Results General characteristics:There were no significant differences between LATG and OTG in sex, age, BMI, comorbidity, tumor bleeding.Operative outcomes and Postoperative outcomes:There was no significant differences between LATG and OTG in NO. of lymph nodes removed, postoperative complications and intraoperative blood loss. The operation time of LATG was longer than OTG. But upon length of incision, time to bowel opening, time to liquid diet, total hospital day, the LATG had significant advantages.ConclusionCompared to ORG, LATG is safe, effective and less invasive in treating upper gastric cancer, which contributes to earlier bowel opening, earlier recovery to liquid diet and short hospital day.