| Background: Gastric cancer(GC)is still a challenging disease that is difficult to effectively treat [1].Surgical treatment is the only cure option for potentially curable advanced gastric cancer and the best chance for long-term disease control,but the recurrence rate and mortality rate of gastric cancer are still very high [2-6].D2 gastrectomy is a recommended operation for curable locally advanced gastric cancer [7-8].Systematic Mesogastric Excision was proposed by Japanese scholars based on embryology and membrane anatomy [9-12],current study has proved its feasibility and safety in the distal stomach surgery.However,there are few studies on the application of SME in total gastrectomy based on the theory of membrane anatomy.Based on existing studies,we initiated this single-center,prospective,randomized controlled trial to evaluate the effect of SME in laparoscopic total gastrectomy for gastric cancer.Objective: To evaluate the feasibility and safety of SME in laparoscopic total gastrectomy for gastric cancer.To compare the clinical efficacy of SME+D2 laparoscopic total gastrectomy for gastric cancer and standard D2 laparoscopic total gastrectomy for gastric cancer.Methods: Our study is a prospective randomized controlled clinical trial.The patients were randomly divided into two groups: SME+D2 group(n = 40)and D2 group(n = 43).Finally,40 cases were included in SME+D2 group and 43 cases in D2 group.The perioperative preparation and management of the two groups were carried out according to the concept of ERAS.SME plus D2 total gastrectomy was performed in SME+D2 group,and standard D2 total gastrectomy was performed in D2 group.The main clinical indicators were the number of intraoperative lymph node dissection,intraoperative blood loss,operation time,and intraoperative adverse events were recorded and compared according to the intraoperative adverse event scoring system(Intraoperativeadverseeventsi AEs).The secondary observation indicators were the first exhaust time after operation,the days of hospitalization,and the complications related to short-term operation.Results: A total of 83 patients were included in the final analysis,including 40 patients in the SME+D2 group and 43 patients in the D2 group.There was no significant statistical difference in preoperative general clinical characteristics between the two groups of patients and they were comparable.The i AES score in the two groups showed that intraoperative injuries were significantly reduced in the SME+D2 group(P < 0.05).Compared with D2 group,SME+D2could significantly shorten the operation time and reduce the amount of intraoperative blood loss,and the difference between the two groups was statistically significant(P < 0.05).The number of dissected lymph nodes in SME+D2 group was(30.53±4.56),which was higher than that in D2 group(28.40±6.11),but the difference between the two groups was not statistically significant(P > 0.05).Compared with D2 group,the first postoperative scheduling time in SME+D2 group was shorter,and the difference was statistically significant(P < 0.05).There was no significant difference in the duration of postoperative fluid feeding and postoperative hospital stay between the two groups(P > 0.05).There was no significant difference in postoperative complications between the two groups(P > 0.05).Conclusion: The results of this study show that the SME+D2 group had shorter operation time,less intraoperative blood loss,reduced the number of intraoperative adverse events,but there was no significant difference in lymph node dissection between the two groups.Compared with the D2 group,patients in the SME+D2 group had earlier postoperative exhaust.There were no significant differences between the two groups in the number of days in hospital or the number of operation-related complications.We believe that SME+D2 laparoscopic surgery makes full use of the advantages of surgical anatomy and embryology,reduces the intraoperative injury,and is conducive to postoperative recovery.This study proved that SME+D2 surgery is a safe,efficient and feasible operation. |
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