A Comparative Study Of The Recent Outcomes Of Reduced-port And Conventional Five-port Laparoscopic Radical Gastric Cancer Surgery

Objective: To investigate whether there is a significant difference in the recent outcomes between reduced-port laparoscopy and conventional five-port laparoscopic radical gastric cancer surgery,and the safety and feasibility of using reduced-port laparoscopy in radical gastric cancer surgery,with a view to providing a scientific basis for the choice of clinical surgical approach.Methods: In this study,a retrospective case-control study was conducted to collect data on patients who underwent laparoscopic radical gastric cancer surgery at the Department of Gastric and Small Intestine Surgery,Third Affiliated Hospital of Kunming Medical University(Yunnan Cancer Hospital)between September 2020 and September 2022.150 clinical and perioperative data on gastric cancer were collected after screening according to inclusion and exclusion criteria.The surgeries were performed by the same team of surgeons.70 patients underwent radical laparoscopic surgery for gastric cancer with reduced ports and 80 patients underwent radical laparoscopic surgery for gastric cancer with five ports.stage I patients underwent D1 lymph node dissection and stage II-III patients underwent D2 lymph node dissection.The observation indicators are divided into 3 areas as follows:(1)General information of the patients: gender,age,Body Mass Index(BMI),extent of surgical resection and tumor location in both groups;(2)Perioperative information of the patients: operating time,intraoperative bleeding,number of positive lymph node metastases,total number of lymph node dissection,time of postoperative gastric tube removal,frequency of postoperative analgesics and postoperative tumor size in both groups(3)Postoperative data: postoperative TNM stage,time of first bowel movement after surgery,time of first fluid intake after surgery,number of days of postoperative hospitalization,postoperative Clavien-Dindo complication classification in both groups.As this was a non-randomised study,there were differences in general information between the two groups,and to balance the baseline differences between the two groups,a 1:1 propensity score matching(PSM)method with a caliper value of 0.02 was used for the single-incision plus one port group and the five-port group.the balancing factors for PSM included gender,age,body mass index(BMI),tumour location,and extent of surgical resection.The general information,perioperative related conditions and postoperative related conditions were compared between the two groups of patients after PSM.Results: 1.A total of 150 patients were screened,including 101 males and 49 females.A total of 104 patients were included after PSM,52 in the reduced-port group and 52 in the five-port group.The difference between the age and extent of surgical resection between the two groups before PSM was statistically significant(P < 0.05).After PSM,a total of 104 patients were included,52 in the reduced-port group and 52 in the five-port group.The differences in baseline indicators between the two groups after PSM were not statistically significant(P > 0.05).2.After PSM,there was no statistically significant difference between the reduced-hole group and the five-hole group in terms of operative time,number of positive lymph node metastases,total lymph node dissection,and tumour size(P >0.05).The differences between the two groups were statistically significant in terms of time to gastric tube removal,frequency of postoperative analgesic medication,wound length and bleeding volume(P < 0.05).3.After PSM,the differences between the reduced-perforation and five-perforation groups in terms of postoperative hospital stay and time to first postoperative bowel movement were statistically significant(P < 0.05).The differences between the two groups in terms of postoperative TNM staging and time to first postoperative fluid intake were not statistically significant(P > 0.05).4.After PSM,a total of 104 patients were included in the two groups,of which 8patients developed postoperative complications,including 2 in the reduced-port group and 6 in the five-port group,with a complication rate of 7.7%.The difference between the two Clavien-Dindo complication grades was not statistically significant(P >0.05).Conclusion: Compared to conventional five-hole laparoscopic radical gastric cancer surgery,reduced-hole laparoscopic radical gastric cancer surgery is safe and feasible,and is beneficial in reducing postoperative pain,reducing wound length,shortening hospital stay and speeding up patients’ postoperative recovery.