| Objective:By comparing the clinical differences of laparoscopic assisted en bloc mesogastric excision and laparoscopic assisted D2 radical gastrectomy for distal gastric cancer to explore the feasibility and safety of laparoscopic assisted en bloc mesogastric excision for distal gastric cancer,and to improve clinicians’ understanding of laparoscopic assisted en bloc mesogastric excision.Methods:To collect the clinical data of patients with distal gastric cancer undergoing laparoscopic surgery from Jan.2013 to Jan.2015 in the Second Hospital of Jilin University.According to different surgical methods,the patients were divided into laparoscopic assisted en bloc mesogastric excision group(EME group)and laparoscopic assisted D2 radical gastrectomy group(D2 group).To collect the following index: intraoperative blood loss,operation time,number of lymph node dissections,blood transfusion rate,first postoperative vent time,postoperative hospital stay,postoperative complications,3-year recurrence and metastasis rate,3-year overall survival and mortality,etc.And to summarize and analyze the collected clinical data.Results:86 patients in the EME group and 95 patients in the D2 group were included in the study.Baseline data such as sex ratio,age,tumor size,and tumor stage were not statistically different between the two groups(P > 0.05),and they were comparable.The amount of intraoperative blood loss in the EME group was(116.9±31.1ml)less than that in the D2 group(120.3±41.8ml),but there was no significant difference between the two groups(P > 0.05).The operation time of EME group and D2 group was 184.0±41.5min and 192.8±50.1min,respectively.There was no significant difference between the two groups(P > 0.05).The number of lymph nodes removed by surgery was 29.5±7.4 and 26.0±5.7 in the EME and D2 groups,respectively,and the number of lymph nodes in the EME group was significantly increased(P <0.05).The transfusion rate was 12.7% in the EME group and 17.9% in the D2 group.There was no significant difference between the two groups(P > 0.05).The first postoperative vent time in the EME group was 2.7±0.8 days,and the first postoperative vent time in the D2 group was 3.0±0.9 days.The first postoperative vent time in the EME group was significantly shorter(P <0.05).The postoperative hospital stay in the EME group was 8.6±2.0 days,the postoperative hospital stay in the D2 group was 9.2±2.4 days.There was no significant difference between the two groups(P > 0.05).Surgical complications: 1 case of incision infection in the EME group,2 cases of pulmonary infection,1 case of postoperative abdominal hemorrhage,1 case of duodenal stump fistula,1 case of anastomotic leakage,1 case of anastomotic stoma,1 case of bowel obstruction,4 cases of lymphatic fistula,1 case of gastric dysmotility;3 cases of incision infection in D2 group,1 case of pulmonary infection,1 case of duodenal stump fistula,1 case of intestinal obstruction,2 case of gastric dysmotility,1 case of reflux esophagitis.There was a statistically significance(P < 0.05)in difference of the incidence of lymphatic spasm between the two groups.There was no significant difference between other complications and overall complications(P > 0.05).At the third year after operation,29 patients in the EME group relapsed and metastasized,accounting for 33.7% of the total,and 32 patients died,of which,27 patients died of recurrence and metastasis,5 patients died of other causes;43 patients in group D2 relapsed and metastasized,accounting for 45.3% of the total,40 patients died.Of the deaths,39 died of recurrence and metastasis,and 1 died of other causes.The 3-year recurrence rate(33.7%)in the EME group was lower than that in the D2 group(45.3%),but there was no significant difference between the two groups(P > 0.05).The 3-year overall survival rate was 62.8% in the EME group and 57.9% in the D2 group.There was no significant difference between the two groups(P > 0.05).The 3-year overall survival rate of each TNM subgroup was also not statistically significant(P > 0.05).Conclusion:1.Laparoscopic assisted en bloc mesogastric excision is safe and feasible in radical distal gastrectomy.2.Laparoscopic assisted en bloc mesogastric excision was not inferior to laparoscopic assisted D2 radical gastrectomy in terms of operation time,intraoperative bleeding,postoperative hospital stay,overall complications,3-year recurrence and metastasis rate,and 3-year overall survival rate,and has the advantage of a large number of lymph node dissection,short time after the first postoperative discharge,but the incidence of lymphatic fistula increased. |
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