Comparing The Efficacy Of Laparoscopic Assisted Radical Total Gastrectomy With Open Total Gastrectomy

Objective:To compare the efficacy and safety of laparoscopic assisted radical total gastrectomy in the treatment of cancer of the cardia and fundus with open total gastrectomy.Methods:The clinical data of 119 patients with cancer of the cardia and fundus who received radical total gastrectomy at our hospital from January 2011 to January 2016 were retrospectively analyzed.All patients have been diagnosed after a series of checks.The location of the tumor and infiltration depth was clear.The comprehensive assessment of lymph node metastasis was unequivocal.It was determined that there was no the liver、 peritoneum and distant metastases.If necessary we could take some living tissues to the pathologic examination in the surgery.So we may further understanding tumor infiltration depth 、lymph node metastasis and tumor stage.Inclusion criteria:1、 The infiltration depth of gastric cancer is <T4a and it can be achieved D2 radical resection;2、The staging of gastric cancer was I、II、III before operation.Exclusion criteria: Excepting the gastric cancer of T4、tumor widely invade surrounding tissues、distant metastasis、the size of tumor<10cm、abdominal adhesion is serious、severe obesity、coagulation dysfunction、 woman during pregnancy、can’t tolerate the pneumoperitoneum、patients with cardiopulmonary,liver and kidney dysfunction.The patients,60 received laparoscopic assisted total gastrectomy(LATG group)and 59 received open total gastrectomy(OTG group).Recording the two groups of patients’ clinical data and making a statistical analysis.Using the SPSS 22.0 as statistical method.Difference of measurement data was compared with analysis of t-test.While the enumeration data was used chi-square test.Using the Wilcoxon test analyzed the survival rates.When the P<0.05,it was significant statistically difference.Results:All the operations were successfully carried out.LATG group without turned to open.Time of surgery was(229.22±24.86)min in the LATG group and(208.47±23.47)min in the OTG group.The intraoperative blood loss was(156.83±55.52)ml in the LATG group and(359.32±72.16)ml in the OTG group.The first day of WBC、N%、CRP after surgery were(8.63±2.31)*109/L、(79.6±6.4)% 、(23.31±8.97)ng/L in the LATG group and(11.88±3.01)*109/L、(84.2±5.3)% 、(40.20±14.28)ng/L in the OTG group.The time to first flatus were(3.72±0.58)d(days)and(5.02±0.99)d in the LATG group and OTG group.The postoperative hospital stay were(11.17±3.14)d in the LATG group and(12.39±3.39)d in the OTG.There were significant differences in the surgery of time、intraoperative blood loss、The first day of WBC、N%、CRP after surgery、time to first flatus and postoperative hospital stay between the LATG group and OTG group(t=4.678,17.172,6.601,4.202,5.905,8.733,2.039,P<0.05).The mean number of lymph nodes dissected was(34.90±5.66)、the morbidity was 13%(8/60)、five-year survival rate was(0.38±0.13)in the LATG group and(35.41±14.25)、16%(10/59)、(0.43±0.11)in the OTG group.There were no statistically significant differences in the mean number of lymph nodes dissected 、the morbidity and five-year survival rate between the LATG group and OTG group(t=0.256,χ2=1.224,Z=0.004,P>0.05).Conclusion:LATG has the similar lymph nodes dissected and no difference in the related complications after surgery、five-year survival rate with OTG.It was also proved that LATG was safe、effective and feasible.And comparing with OTG,LATG has this advantages: incision was beautiful,less bleeding in surgery,less invasive,less stress reaction and recover more quickly after surgery.