A Matched Cohort Analysis Of Laparascopic-Assisted Total Gastrectomy Versus Conventional Open Total Gastrectomy For Gastric Cancer

Objective:To evaluate the feasibility, safety and short-term outcomes of 1aparascopic-assisted total gastrectomy (LATG) with D2 lymphadenectomy and palliative total gastrectomy for gastric cancer. Methods:Retrospective review the clinical data of 32 patients with gastric cancer who were treated by LATG. These patients were then compared with a cohort of 32 patients gastric cancer treated by conventional open total gastrectomy (OTG), who were matched in respect of sex, age, BMI (Body Mass Index), the American Society of Anesthesiologists physical status classes, TP, AL, hemoglobin, whether or not receiving neoadjuvant chemotherapy and the UICC(1997)'s stage, site of tumor and the histologic type and Bormann type of pathology. The safety, recovery and oncological clearance of two groups were compared.Results: All patients in the laparoscopic surgery group underwent LATG and lymphadenectomy successfully without conversion to open surgery. 27 cases were performed LATG with D2 lymphadenectomy, included 1 case of them combined distal pancreatectomy with D2 lymphadenectomy. 5 cases were performed palliative total gastrectomy. The mean operating time of the laparoscopic surgery group and the open surgery group were ( 220.78±44.34 ) and (178.44±29.06)minutes, it was significantly longer than that of open surgery group (P < 0.05). The mean length of incision, first flatus time, time to initiate oral intake in the laparoscopic surgery group was ( 5.50±0.57 )cm, ( 3.63±1.04 )days, (3.94±0.84 )days, respectively, which was significantly lesser or shorter than those the open surgery group. Leukocyte counts on day 1, 3 and 7 were significantly lower in laparoscopic surgery group than in open surgery group. The time to first flatus, time to initiate oral intake, and postoperative hospital stay was significantly shorter (P < 0.05) in the laparoscopic surgery group than in the open surgery group. The increase value of leukocyte and granulocyte count in the laparoscopic surgery group on day 1 was (6.61±2.92 )×109/L, ( 7.32±3.01 )×109/L, respectively. The increase value of leukocyte and granulocyte count in the laparoscopic surgery group on day 3 was ( 3.99±3.83)×109/L,( 4.48±3.94)×109/L respectively, which was significantly lesser than those in the open surgery group. The number of harvested lymph nodes of total, the first leg and the second leg was ( 26.41±13.71 ), ( 17.13±9.13 ) and ( 9.22±8.16 ) respectively, there was no significant difference between the laparoscopic surgery group and the open surgery group. The rate of infection of incisional wound in laparoscopic surgery group was lesser than that in the open surgery group. The rate of pulonary infection in the laparoscopic surgery group was higher than that in the open surgery group, but there was no significant differences between them. There was not comparable in two groups in other complication rate and total complication rate, too. The effect of follow-up visit in the near future after operation was well.Conclusions: Comparing with OTG, LATG consume more time. But LATG with D2 lymphadenectomy can achieve the same cancer clearance as OTG, and LATG could reduce minimally invasive, less acute-phase response after surgery and leads to quick post operative recovery. LATG is a safe, feasible and minimally invasive surgical technique.