| Background and Objective:Laparoscopic-assisted gastric surgery has become an option for the treatment of early gastric cancer. However, there are few reports of laparoscopic surgery in the management of advanced gastric cancer. In this study we investigated the feasibility, safety and cancer clearance of laparoscopy-assisted gastrectomy with D2 lymphadenectomy.Methods:Between January 2006 and December 2007,7 patients with AGC underwent laparoscopic gastric resection at First Affiliated Hospital of Shantou University Medical College. 6 of those patients underwent LAPG or LADG accompanied by D2 lymphadenectomy successfully and were enrolled in this study (LAG Group), except one converted to laparotomy. These patients were compared and analyzed retrospectively with 17 patients who had AGC and underwent conventional open gastrectomy during the same period (OG Group).Results:Operation time was significantly longer in the LAG Group than in the OG Group (361±73min vs.209±71 min, p<0.001). Estimated blood loss, time to first flatus, time to liquid diet after operation and postoperative LOS in the LAG Group were less than in the OG Group (166.7±51.6ml vs.214.3±56.9ml,4.7±1.0d vs.5.4±1.6d,5.8±0.8d vs. 6.5±1.4d,11.8±1.7d vs. 12.82±2.8d), with no statistically significant difference(p>0.05); The number of times analgesics given and time to ambulation in the LAG Group were less then in the OG Group (1.17±0.41 vs. 3.52±0.8,2.83±0.75d vs. 5.18±1.07d, p<0.001), with statistically significant difference. The mean number of nodes resected with laparoscope was 16.2±2.4, lower than that with ODG (17.1±4), with no statistically significant difference. Both of them reached the tumor classification (15) requirements. Proximal and distal margins in each group were no involvement. There was 1(16.67%) patient had postoperative fever in LAG Group, and that were 8(50%) cases in OG Group. There were other complications in OG Group:abdominal distension, lymph leak, anastomotic leakage, Anastomotic inflammation, postoperative low SP02, one case in each. The morbidity rate in LAG Group was also lower than in the 0-group, with statistically significant difference (16.7% vs. 70.5%, p=0.032). The mean follow-up for the LAG Group was 33±8 months, with no recurrence and death. The mean follow-up for the OG Group was 37±6 months, one patient had recurrence in gastroesophageal anastomotic stoma after 2 years, and another had cancer cells found in ascites in 2 years postoperative.Conclusions:laparoscopy-assisted gastrectomy with D2 lymphadenectomy for AGC is a feasible and safe procedure, and compared to traditional open surgery has several advantages, such as fewer effect on the appearance, fewer pain and rapid recovery. Moreover, this method can achieve a radical oncologic equivalent resection. |
