| BackgroundGastric cancer is one of the most frequently occurring cancer and the incidences are highly in east Asian countries such as China,Japan and Korea according to the World Health Organization.The number of new cases has climbed to more than four hundred thousands per year and over three hundred thousands died due to gastric cancer.Because of serious imbalance of distribution in medical resources of china,it is difficult to carry out to screening high-risk group.Meanwhile,there is no special sign and symptom in patients at an early stage.The number of patients with early gastric cancer(EGC)would account for less than 10 percent of the hospitalized patients.The majority of patients are diagnosed with advanced stage which reveals poor prognosis because of the metastasis of lymph node,blood and peritoneal.For now,radical surgery is still a hoping curative method for gastric cancer.The radical gastrectomy for gastric cancer has been achieved progressively in recent two decades,not just in the improvement of the radical resection and survival rate,it also displays by the rapid development of minimally invasive surgery that represented by Da Vinci surgical robotic system and gastrectomy surgery.Minimally invasive surgery has become one of the main direction of modern surgery.Since the first describe of laparoscopic distal gastrectomy for early gastric cancer by professor Kitano,it has gradually accepted by the surgeon because of the advantages of less surgery trauma,rapid postoperative recovery,low incidence rate of postoperative complications and short hospital stay.laparoscopic gastrectomy is the standard therapy for patients at stage IA as described in Japan stomach cancer treatment guideline 2002.Goh et al were the first to report the use of laparoscopic gastrectomy with D2 lymph node dissection with advancement of laparoscopic gastrectomy in1997.Cases report about the application of this treatment gradually increased and several research shows that for AGC laparoscopic gastrectomy with D2 lymph node dissection is safe and feasible.However,the long-term outcomes of laparoscopic gastrectomy for advanced gastric cancer still remains controversial due to its technical difficulty.The studies on this problem is concentreated on the short term and mid term efficacy and large amount case-control with long-term follow-up had been seldom reported.ObjectiveThis study was designed to evaluate the long-term clinical outcomes between Laparoscopic and open distal gastrectomy with D2 lymph dissection for advanced gastric cancer during the period from Janurary 2004 and June 2010 in Department of general surgery,Southwest hospital,Third Military Medical University and aim to provide more clinical evidence-based results for the widely applied of this procedure.Methodswe retrospectively analyzed the clinical data of patients who underwent radical distal gastrectomy with D2 lymph dissection at Department of general surgery,Southwest hospital,Third Military Medical University from Janurary 2004 and June 2010.The patients with perioperative other malignant tumors,metastasis to other organs,emergency surgery,preoperative adjuvant chemo-radiotherapy and remnant gastrectomy were excluded.Surgical outcomes,postoperative complications and long-term results were compared.All statistical analyses were performed using SPSS 19.0 statistical software(SPSS,Inc.,Chicago,IL).chi-square test and the independent samples t test were used for comparisons between the two groups.The overall survival(OS)and disease-free survival(DFS)rates were assessed by Kaplan-Meier analysis and compared by the log-rank test.ResultThe baseline information of the patients,such as sex,age,tumor location,clinical tumor stage(7th),body mass index(BMI)and American Society of Anesthesiologists(ASA)score were similar between the two groups.Compared with conventional open group,LG group was associated with a lower intraoperative blood loss(125±89 vs 290±161,t=-16.92,P<0.05),a shorter time to oral intake(2.9±0.7vs 4.1±1.6,P<0.05)quicker anal exsufflation(2.7±1.4vs3.6±1.6,P<0.05)shorter postoperative hospitalization(7.7±3.6vs10.1±4.1,P<0.05).In addition,there was no significant difference in the operative time(207±57vs202±43,P>0.05)number of retrieved lymph nodes(32.8±12.9 vs 31.2±15.4,P>0.05)resection margin(P>0.05)between the two groups.The postoperative complication rates in the LG group were significantly lower than in the OG group(7.2% vs.12.6 %,p<0.05).During the median follow-up of 86 months(range,3-140months),recurrence occurred in 171 patients and 181 patients died at 5 years in LG group.recurrence occurred in 140 patients and 151 patients died at 5 years in OG group.7 patients were treated with reoperation and 1 patient died due to intra-abdominal bleeding in LG group.6 patients were treated with reoperation and 2 patient died in OG group.One patient died due to intra-abdominal infection and the other died due to pulmonary infection with respiratory failure.The differences in 5 year overall survival rate between the two groups were not statistically significant(52.0%vs49.8% P > 0.05).No statistical difference were seen in 5 year disease-free survival rate(49.9%vs47.8% P> 0.05).The 5-year overall survival(OS)rates for the patients after laparoscopic and open distal gastrectomy with D2 lymph dissection for advanced gastric cancer: 83.6% versus 80.8% for the patients with stage IB disease(χ2=0.143、P=0.706);63.4% versus 62.5% for the patients with stageⅡA disease(χ2=0.001、P=0.979),53.4% versus 50.0% for the patients with stage ⅡB disease(χ2=0.404、P=0.525),36.2% versus 35.6% for the patients with stage ⅢA disease(χ2=0.018、P=0.894),28.6% versus 27.9% for the patients with stage ⅢB disease(χ2=0.057、P=0.811),26.9% versus 23.8% for the patients with stage ⅢC disease(χ2=0.013、P=0.909),There were no differences between the two groups in each stage(P>0.05).the 5-year disease-free survival(DFS)rates for the patients after laparoscopic and open distal gastrectomy with D2 lymph dissection for advanced gastric cancer: 80.6% versus 78.8%for the patients with stage IB disease(χ2=0.062、P=0.804),62.0% versus 60.7% for the patients with stageⅡA disease(χ2=0.002、P=0.967),51.1% versus 48.6% for the patients with stage ⅡB disease(χ2=0.209、P=0.647),34.8% versus 33.9% for the patients with stage ⅢA disease(χ2=0.009、P=0.926),26.8% versus 25.6% for the patients with stage ⅢB disease(χ2=0.060、P=0.806),23.1% versus 19.0% for the patients with stage ⅢC disease(χ2=0.020、P=0.887),There were no differences between the two groups in each stage(P>0.05).ConclusionOur results suggest that Laparoscopic distal gastrectomy with D2 lymph dissection for advanced gastric cancer is a safe and feasible,with the advantages of better short-term efficacy and has comparative long-term oncologic outcomes compared with conventional open surgery. |
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