Clinical Application Of Laparoscopic Techniques In Gastric Cancer

ObjectiveTo investigate the application and effectiveness of laparoscopic surgery for gastric cancer. Materials and methodsFrom December 2012 to December 2015, patient undergo laparoscopic radical resection of gastric cancer or laparotomy for gastric cancer in Department of general surgery of people's Hospital of Zhengzhou University were enrolled in this study. First, the safety of laparoscopic technique in radical surgery of gastric cancer was evaluated. Second, values and advantages of laparoscopic technology application in obese patients with gastric cancer and gastric stump cancer were analysis. There are two aspects included in this study: fisrt, efficacy of laparoscopic radical gastrectomy vs. open surgery; second, efficacy of laparoscopic surgery and open surgery in obese patients with gastric cancer. In order to investigate the value of laparoscopic radical gastrectomy, the following parametes were included: operation time, lymph node dissection, intraoperative blood loss, operation time, backward liquid solid intake time, exhaust time, extubation time, indwelling catheter time, postoperative analgesic use cases, the total cost of hospitalization, incision length, postoperative complications length of stay, and 1-3 year survival rate. ResultsThere were no significant difference in radical resection of gastric cancer, BMI, gender, age were near margin length, number of lymph node dissection, postoperative pathologic staging and tumor diameter between laparoscopic group and laparotomy group(P>0.05). Laparoscopic group were significantly superior to control group at following aspects:bleeding volume, intraoperative backward backward liquid solid feeding time, exhaust time, extubation time, indwelling catheter time, postoperative analgesic use cases, incision length, postoperative hospitalization time, postoperative complications(P<0.05). There were no significant difference in Postoperative lymph nodes between laparoscopic group and laparotomy group(P>0.05).The cost of laparoscopic group was significantly higher than that in open surgery group(P<0.05). In obese patients with gastric cancer, there were no significant difference in sex and age, BMI, near margin length, number of lymph node dissection, postoperative pathologic staging and tumor diameter surgery between laparoscopic group and laparotomy group(P>0.05). Laparoscopic group were significantly superior to control group at following aspects: the amount of bleeding, exhaust time, length of incision, postoperative use of analgesics in terms of the number of cases, surgery after liquid time after operation, the application of analgesics and the lenth of stay(P<0.05). There was no significant difference in the incidence of postoperative complications between laparoscopic group and open group(P>0.05), The cost of laparoscopic group was significantly higher than that in control group(P<0.05). There was no significant difference in survival rate between the two groups(P> 0.05).There were some findings in laparoscopic surgery in patients with gastric stump cancer surgery: operation time 160-310 min, average(200 + 55) min; intraoperative bleeding 10-200 m1,average(110 + 80) ml. The number of lymph nodes is 12-35 on average(19 + 7.0); postoperative anal exhaust time is 2-5d, the average(3.1 + 1) d; intraoperative backward semi liquid diet time 4-10 d, average(5.3 + 1.6) d; postoperative ambulation time 1-3D, average(1.6 + 0.8) d; postoperative hospital stay 7-15 D, the average(8.4 + 3) d; the total hospitalization expenses(million yuan) 4.5-9.1 million yuan, the average(59+1.3) thousand yuan; the incidence of postoperative complications was 6.6%(2/30); median follow-up of 18 months, the follow-up rate was 93.4%. During the follow-up, 2 patients died of liver metastasis, 6 patients died of peritoneal metastasis, and 20 patients were in good general condition. ConclusionsFirst, laparoscopic radical gastrectomy in treatment of gastric cancer is safe and feasible. The efficacy of laparoscopic radical gastrectomy is similar with open surgery, less bleeding, less trauma, faster postoperative recovery, shorter hospitalization, eating early days of laparoscopic radical resection of gastric cancer. Laparoscopic radical gastrectomy for gastric cancer is becoming gradually mature, which can achieve the same curative effect with open surgery and has minimally invasive advantages. Second, the laparoscopic technique, with obviously advantages of minimal invasive, is not contraindicant opreration in obese patient with gastric cancer. Third, laparoscopic operation in patients with gastric stump cancer is safe and effective, and it is worthy of clinical advocate.