| Objective:To investigate the short-term and long-term outcome of laparoscopic gastrectomy for T4a gastric cancer.Methods:The Clinical and follow-up data of102T4a gastric cancer patients who underwent laparoscopic radical gastrectomy in Shanghai Minimally Invasive Surgery Center between January2004and December2011were analyzed retrospectively. The safety and feasibility were evaluated according to operative time, blood loss, postoperative complications and postoperative recovery. The curative effect was evaluated according to the cutting edge and the number of dissected lymph node. The cumulative overall survival and cancer free survival were determined by the Kaplan-Meier method, univariate analysis for prognosis was performed and multivariate analysis was performed using the Cox regression model, risk factors for recurrence was evaluated by chi-square test.Results:All the102T4a patients underwent laparoscopic radical gastrectomy, the mean operative time was240.4±52.9min, intraoperative blood loss was235.4±155.0ml, the average time to first flatus was3.0±1.3d, the average time to first liquid intake was4.7±1.3d, the average time to semiliquid intake was7.3±1.5d, postoperative hospital stay was11.5±8.4d. The overall postoperative complication rate was13.7%, among which anastomotic leakage was major complications. The average distal and proximal resection margins were4.4±2.8cm and4.0±2.6cm, respectively. The average number of retrieved lymph node was21.6±10.8. The average total cost was32211.84±12942.66RMB. Recurrence was observed in47cases, and the recurrence rate was46.1%. The cumulative5-year overall survival, cancer free survival and cancer related survival rates were45.9%,49.3%and47.6%respectively. Univariate analysis showed that tumor size, pathological type, number of lymph node metastasis and metastatic lymph node ratio were risk factors for overall survival. Multivariate analysis showed that metastatic lymph node ratio and pathological type were independent risk factors for overall survival in T4a patients after laparoscopic surgery. The metastatic lymph node ratio was independent risk factors for cancer free survival. The number of metastatic lymph nodes and metastatic lymph node ratio were risk factors for recurrence.Conclusions:Laparoscopic radical gastrectomy for T4a gastric cancer is safe and feasible, with similar curative effect and long-term outcome of traditional open surgery. Pathological type and metastatic lymph node ratio were independent risk factors for overall survival. Tumor size can be combined with medical image to do a more accurate preoperative evaluation. Patients with high metastasis lymph node ratio and late N stage should be paid more attention during postoperative follow-up. |
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