| Laparoscopic surgery for gastric cancer is considered as a new technique in minimally invasive and radical resection. At the same time.minimally invasive surgery may lead to some distinguished clinical superiority in less suffering, less bleeding and better postoperative quality of life.Today,laparoscopy can be applied in not only preoperative diagnosis of gastric cancer but also radical gastrectomy.The result of laparoscopic radical excision for early gastric cancer without lymph nod metastasis has been proved equal to that in open surgery. With the development of technique and surgical therapy mode, laparoseopic surgery is possible to substitute traditional open surgery step by step.The microinvasiveness of laparoscopic surgery has prompted the exploration of its use in nearly every fields of abdominal surgery. Although the use of laparoscopic technique in malignant neoplasms has been hotly debated over the last decade due to concerns over its effectiveness in lymphadenectomy,reported higher rate of port site rucurrence and the possible side effect it might have on peritoneal metastasis.Laparoscopic radical surgery for gastric cancer,has developed slowly as compared with laparoscopic colorectal surgery due to the complicated anatomy and the complexity of D2 lymphadenectomy which is cosidered mandatory by Asian surgeons for the cure of most gastric cancers.There are only few reports on laparoscopic D2 lymphadenectomy with limitted cases.This paper is to investigate the feasibility,safety and cancer clearance of laparoscopy-assisted gastrectomy with D2 lymphadenectomy for early gastric cancer as well as some advanced gastric cancer.With comparison to the result of open surgery,the short-term follow up result of laparoscopic gastric surgery will also be provided.The effect of laparoscopic gastrectomy on postoperative qulity of life is also investigated.Peritoneal carcinomatosis is the first cause of death for patients after radical gastrectomy.Pathoclinical data and methods:Review 2007.3-2009.12 16 routine of laparoscopicradical gastrectomy had been completed successfully. Therewere 4 procedures of laparoscopic total gastrectomy,5 procedures of proximalgastrectomy,6 distal procedures of proximal gastrectomy. Data from these laparoscopic procedures was compared with that from 30cases of open surgery.The following indices were observed:operation time,blood loss,times of analgesic injection,time to ingestion,postoperative complications,tumor margin and number of lymph nodes dissected. All patients were followed up to record the time of recurrence and death.Results:The mean operation time of laparoscopic radical surgery is significantly longer than that of open surgery (6.5±1.8 vs 4.2±1.3h).The mean blood loss in laparoscopic group is significantly lower as compared to open group(135.5±10.9 vs 126.8±15ml).A mean of 22.3±12.7cm lymph nodes were dissected in laparoscopic group,which is comparable to that in open group 25.1±10.4 cm.The mean clear proximal and distal margin from tumor in laparoscopic group is 4.9±1.6cm and4.7±1.2cm respectively,without significance as compared to that in open group(5.4±1.7cm and5.8±1.3cm).Pathological examination revealed no positive margin.There was no postoperative death in laparoscopic group,but 1 death in open group due to anastomotic leakage and pulmonary infection.The mobidity rate without statistical difference.The laparoscopic group patients had a better quality of life,as indicated by a better global score and physical function.4 patients died in laparoscopic group,7patients died in open group, there was no significant difference in survival rate as well as the ranking of causes of death between two groups.Conclusion:vesssed early cancer and stomach serosal invasion of small area of adanced gastric cancer, aided by laparoscopic vesssed technically gastric D2 is safe and feasible. Laparoscopic surgery in clinical applications will be more and more widely。Laparoscopical D2 lymphadenectomy with the benefit of minimal invasiveness,less blood loss and quicker postoperative recovery. |
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