| Background:The overall strategy for the treatment of gastric cancer is comprehensive treatment based on surgery.For early-stage gastric cancer located at middle and lower gastric wall,traditional 5-port laparoscopic distal gastrectomy was the standard treatment.With the development of minimally invasive concepts and technologies,Reduced-port laparoscopic distal gastrectomy was gradually accepted by surgeons and patients as a more minimally invasive surgical treatment.However,the safety,feasibility and effectiveness had not yet been verified thoroughly with high-rank evidence.Thus,the purpose of this study is to evaluate the safety,postoperative recovery and cosmetic score of Reduced-port laparoscopic distal gastrectomy.Chapter ?:Surgical safety of Reduced-port laparoscopic distal gastrectomy with D2 lymphadenectomy:a retrospective single arm trialMethods:Single-arm analysis of the surgical safety of Reduced-port laparoscopic distal gastrectomy,the 30 consecutive patients underwent Reduced-port laparoscopic distal gastrectomy in the department of general surgery,Nanfang hospital from November 2016 to August 2018.Results:No major complication and deaths were observed intraoperatively.Means of operation time,blood lost,the number of retrieved lymph nodes were 197.8±46.9min,30(31.25)ml,and 38.7±14.1,respectively.5-port conversion rate was 3.3%(1/30),no open conversion occurred.Means of time to postoperative first flatus,time to first soft diet intake,time to removal of drainage tube and postoperative hospital stay were 45.3± 18.9 h,87.6±35.6 h,101.8±58.0 h and 6.1 ±2.1d,respectively.80%of patients had no additional analgesics use.The postoperative complication rate within 30 days was 16.7%.And 96.7%(29/30)of the patients' cosmetic score rated from 18 to 24.Conclusion Reduced-port laparoscopic distal gastrectomy is safe and feasible with acceptable short-term outcomes and better cosmetic outcomes in selected patients for experienced surgeons.Chapter ?:Surgical safety of Reduced-port laparoscopic distal gastrectomy with D2 lymphadenectomy:a propensity score matching analysisMethods:From March 2008 to March 2021,1601 consecutive gastric patients underwent Reduced-port laparoscopic distal gastrectomy.Among them,1503 patients underwent traditional 5-port laparoscopic surgery,98 patients underwent reduced-port laparoscopic surgery.After generating propensity scores with three covariates,including gender,body mass index(BMI)and TNM,96 patients performed with the Reduced-port laparoscopic distal gastrectomy method were one-to-one matched with 96 patients operated with the conventional laparoscopic distal gastrectomy group.The early postoperative safety was compared between the two groups.Results:Both groups were balanced regarding baseline variables.The total operative time(194.3±51.2 min versus 198.4±46.7min,t=-0.576,p=0.565)and the number of retrieved lymph node(39.3 ± 15.0 versus 36.3+22.3min,t=-1.107,p=0.270)were not significantly different between the two groups.While the mean blood loss in Reduced-port laparoscopic distal gastrectomy group were less than in conventional laparoscopic distal gastrectomy group(37.8±33.8 ml versus 95.4±98.8 ml,t=5.409,p<0.001).the Reduced-port laparoscopic distal gastrectomy group has an advantage over conventional laparoscopic distal gastrectomy group during the postoperative recovery course:the time to liquid resumption(2.9± 1.8 d versus 3.8±2.3 d,t=-2.883,p=0.004),soft diet(4.7±2.7 d versus 5.4±1.7 d,t=-2.143,p=0.033)and post hospital stay(7.3±3.8 d versus 9.3±5.3 d,t=0.157,p=0.004)were significantly shorter in Reduced-port laparoscopic distal gastrectomy group.The postoperative complications(Reduced-port laparoscopic distal gastrectomy group:17.7%(17/96),conventional laparoscopic distal gastrectomy:17.7%(17/96),?2=0.001,p=1.000),and even the distribution of severity(x2=-1.148,p=0.251)were similar between the two groups.Conclusions:Reduced-port laparoscopic distal gastrectomy has the similar safety,quicker gastrointestinal recovery,and shorter postoperative hospital stay,compared with conventional laparoscopic distal gastrectomy.Chapter ?:Randomized controlled trial on short-term outcomes of Reduced-port laparoscopic distal gastrectomy versus conventional laparoscopic distal gastrectomy for cStage I gastric cancerParticipants:Patients were diagnosed with primary gastric adenocarcinoma confirmed pathologically by endoscopic biopsy in Nanfang Hospital can be recruited when meeting the inclusion criteria:age from over 18 to under 75 years;the tumor located at middle or lower third of stomach,cStage IA(T1N0)or IB(T1N1,T2N0),while laparoscopic distal gastrectomy is the planning surgery.performance status of 0 or 1 on ECOG(Eastern Cooperative Oncology Group)scale;ASA(American Society of Anesthesiology)score class ?,or ?.Design:a prospective randomized controlled trialArms and InterventionsExperimental(Arm A):Reduced-port laparoscopic distal gastrectomy.Active Comparator(Arm B):conventional laparoscopic distal gastrectomy.Sample size:240(Arm A:120;Arm B:120)Primary endpoint:Early complication rate[Time Frame:30 days]Secondary endpoint:Surgical indexOncology indicatorsEarly recovery process after surgeryPostoperative quality of life:EORTC QLQ-C30/STO22 questionnaire score(30 days after surgery and 90 days after surgery)3-year tumor-free survival rate5-year overall survival rate. |
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