Short-term Efficacy And Safety Of Laparoscopic D2 Radical Surgery And Open D2 Radical Resection In The Treatment Of Advanced Distal Gastric Cancer

Objective:To investigate the short-term efficacy and safety of laparoscopic D2 radical surgery and open D2 radical resection in the treatment of advanced gastric cancer in Yunnan.Methods:To retrospectively analyze the clinical data of patients with advanced distal gastric cancer and D2 radical surgery during the period from January 1,2016 to June 30,2018,Department of Abdominal Surgery,Yunnan Cancer Hospital.The study included 181 patients with advanced distal gastric cancer undergoing radical surgery based on enrollment conditions,including 80 patients in the laparoscopic group(LG group)and 101 patients in the open group(OG group).We record the patient’s general clinical index data:The relevant indicators of surgical quality include the length of the incision,the duration of surgery,the amount of intraoperative blood loss,the positive rate of upper and lower incisional margin of tumor,and the number of lymph node clearance;Postoperative recovery related indicators include postoperative anal exhaust and defecation time,postoperative hospital stay and postoperative blood,liver and kidney function changes;Surgery-related compllications were classified into laparoscopic surgery-specific complications(subcutaneous emphysema,puncture wound,hypercapnia)and surgical complications of gastric cancer(anastomotic fistula,postoperative bleeding,gastric emptying disorder,infection,lymphatic leakage、intestinal obstruction,deep vein thrombosis).1-year follow-up after surgery:tumor recurrence(or)metastasis rate and mortality.After collating relevant data,SPSS22.0 statistical software was used to evaluate the short-term efficacy and safety of laparoscopic D2 radical surgery and open D2 radical resection in the treatment of advanced distal gastric cancer.Results:1.There was no significant difference in the distribution of age,gender,BMI.tumor cell infiltration depth and postoperative pathological stage between the laparoscopic group and the open group(P>0.05).2.The duration of laparoscopic surgery was significantly longer than that of the open group,but there was a significant advantage in intraoperative blood loss,length of incision,anal exhaust time,defecation time.and postoperative hospital stay.The difference was statistically significant(P<0.05).3.There was no significant difference in the positive rate of upper and lower incisional margin of tumor and the number of lymph node clearance between the laparoscopic group and the open group(P>0.05).There were no significant differences in postoperative complications and procalcitonin,white blood cell,percentage of neutrophils,alanine transaminase,and creatinine between the two groups(P>0.05).4.The total bilirubin on the first day after operation in the laparoscopic group was smaller than that in the open group(P<0.05).There was no statistically significant difference in TBIL between the laparoscopic group and the open group at 3-4 days after surgery(P>0.05)5.There was no statistically significant difference in tumor recurrence(or metastasis)and mortality between the laparoscopic group and the laparotomy group within 1 year after surgery(P>0.05)Conclusion:1.Laparoscopic D2 radical surgery for advanced distal gastric cancer has the advantages of small incision,less bleeding,less inflammatory reaction、faster postoperative recovery,and shorter hospital stay than D2 radical surgery.However,there are also shortcomings of longer operation time.2.There was no statistically significant difference between the laparoscopic surgery and the open surgery in the positive rate of upper and lower incisional margin of tumor,the number of lymph node clearance,and the incidence of postoperative complications.At the same time,laparoscopic surgery does not increase the risk of infection and additional damage to liver and kidney function,due to prolonged operation time and unique complications.3.There was no statistically significant difference in tumor recurrence(or)metastasis rate and mortality between the two surgical methods within 1 year after surgery.4.Laparoscopic D2 radical resection is safe and effective in the treatment of advanced distal gastric cancer.Which is basically consistent with the recent surgical treatment of open D2 radical surgery,and it has the advantage of minimally invasive.