The Comparative Study Of Laparoscopy-assisted And Open Surgery On Radical Gastrectomy With D2 Dissection For Gastric Cancer

Objective: To explore the feasibility and clinical outcome of laparoscopy-assisted radical gastrectomy with D2 dissection for comparing the differences between the laparoscopic group and the open group.Methods: Retrospective reviewed the clinical data of 160 cases who were treated with laparoscopic gastrectomy in our hospital from December 2005 to September 2010.Among these cases , radical total gastrectomy (TG+D2) was performed in 106 cases(include 8 cases of combined organs resection), radical distal gastrectomy(DG+D2) was performed in 54 cases.Comparing with the same period 180 cases of open gastrectomy with D2 lymph node dissection including radical total gastreetomy in 147 cases(include 5 cases of combined organs resection),radical distal gastrectomy in 33 cases.The lymph node dissection numbers,blood loss,operation time and postoperative recovery, complications, mortality, and survival rate of two groups were analysed.Results:1.No significant difference was found in the numbers of resected lymph node between these two groups (1aparoscopy-assisted group and open group:26.32±12.93 vs 26.83±11.19 , t=-0.393,P=0.694),no matter which operation the patients underwent(DG+D2:28.77±12.75 vs 27.07±11.51, t=1.107,P=0.269 ;TG+D2:(21.50±12.00 vs 25.76±9.69,t=-1.722,P=0.089),respectively.2.There were significant differences between the two groups in the timing of return to bowel function,first liquid diet ,the 1aparoscopy-assisted group is shorter than open group(,3.6±1.0)day,(3.9±0.8)day, respectively,and the average operation time of the 1aparoscopy-assisted group is significant longer than the open group.The mean volume of blood loss, postoperative hospital stay and postoperation complication,the 1aparoscopy-assisted group is(239.1±132.1)mL,(13.7±5.3)day, 18.75%respectively, no significant difference with the open group. 3.153 patients were followed in the 160 patients of the laparoscopy-assisted group, and all of the 180 patients were followed in the open group, middle follom-up time was 19 months.No significant difference was found in 1-year ,2-year and 3-year survival rate between the two groups, respectively :92.1% VS 93.3%,82.4% VS 88.2% , 57.1% VS 71.4%.Conclusions:1.The 1aparoscopic gastrectomy with D2 lymphadenectomy for gastric cancer is feasible and safe. It is no difference in numbers of resected lymph nodes between 1aparoscopic and open gastrectomy and it can satisfy oncologic criteria.2. Laparoscopic gastrectomy has the advantage of much safer,and the faster postoperative recovery compare with the open group.3. It is no significant difference in 3-year survival rate between the laparoscopic gastrectomy and the open group. The short-term outcome has been confirmed but the long—term outcome is needed to be observed .