Comparative Clinical Efficacy Of Totally Laparoscopic Distal Gastrectomy And Laparoscopic-assisted Distal Gastrectomy For Gastric Cancer

Objective:The aim of this study is to compare clinical curative effect of totally laparoscopic distal gastrectomy(TLDG)and laparoscopic-assisted distal gastrectomy(LADG)for gastric cancer.Methods:In September 2015 to March 2018,this study was retrospective analyzed 90 cases of patients who underwent laparoscopic distal gastrectomy in our department,including 35 cases of patients with TLDG and 55 cases of patients with LADG.Results:This study show that no significant differences in the number of dissected lymph nodes[(36.2±6.5)versus(34.8±7.0),P=0.343]and the time of operative[(275.9±24.4)min versus(285.6±27.9)min,P=0.087]between the patients underwent LADG and the patients underwent TLDG.However there were obvious differences in the blood loss[(143.6±58.6)ml versus(66.6±22.0)ml,P<0.001],the incision length[(7.6±1.0)cm versus(4.2±0.4)cm,P<0.001],the postoperative of draining liquid[(295.0±77.7)ml versus(172.7±99.3)ml,P<0.001],the time to flatus[(3.5±0.6)d versus(2.7±0.5)d,P<0.001],the time to fluid diet[(5.4±0.7)d versus(4.7±0.6)d,P<0.001],and the hospital stay[(14.6±0.8)d versus(13.0±1.2)d,P<0.001]between the patients underwent LADG and the patients underwent TLDG.Meanwhile this study was found that the WBC(white blood cell)count[preoperative:(6.5±1.0)109/l versus(6.2±1.2)109/l,P=0.113;postoperative day 1:(10.1±1.0)109/l versus(9.8±1.2)109/l,P=0.163;postoperative day 5:(7.1±0.9)109/l versus(6.9±1.4)109/l,P=0.492]and the neutrophil count[preoperative:(58.6±7.7)%versus(57.2±6.3)%,P=0.398;postoperative day 1:(78.7±6.8)%versus(76.9±5.5)%,P=0.172:postoperative day 5:(67.2±6.2)%versus(66.7±5.5)%,P=0.687]were no significant differences between the patients underwent LADG and the patients underwent TLDG.This study was also found that the postoperative pain score[postoperative day 1:(6.3±0.9)points versus(3.5±0.9)points,P<0.001;postoperative day 3:(3.3±0.8)points versus(2.5±0.7)points,P<0.001]in the patients underwentLADG were significantly higher than those in the patients underwent TLDG,but the results show that the postoperative pain score[postoperative day 5:(1.6±0.5)points versus(1.5±0.5)points,P=0.162]were no significant differences between the patients underwent LADG and the patients underwent TLDG.Conclusion:This study suggests that TLDG is feasible,compared to LADG,and that it has several advantages over LADG,including minimal trauma,reduce bleeding,shorter hospital stay,postoperative recover fast,relieve pain and good short-term clinical efficacy.