A Case-matched Study Comparing The Short And Long Outcomes Of Laparoscopy-assisted With Open Distal Gastrectomy For Gastric Cancer

Objective:To evaluate the feasibility, safety and the long-term outcomes of laparoscopy-assisted distal gastrectomy (LADG) for gastric cancer by comparison with open distal gastrectomy (ODG).Methods:54cases of laparoscopy-assisted distal gastrectomy for gastric cancer were operated in our department from October2004to October2007.These patients were compared with a cohort of54patients with gastric cancer treated by open distal gastrectomy in the same period in our hospital.They were matched in respect of sex,age,the degree of tumor differentiation, the UICC(2002) s stage. Laparoscopic surgery cases are assigned to the experimental group and open surgery cases are assigned to the control group.The operative time,blood loss,lymph node haryested,operative complications and survival rate of two groups were compared.Results:There were no significant differences between LADG group and ODG group with respect to sex, age, BMI index, ASA status and TNM stage. In the LADG group, all operations were completed successfully without converting to open surgery. Operation time was significantly longer in the LADG group than in the ODG group (259.3±46.2min vs199.8±40.8min, P<0.01), However, the blood loss were significantly lower in the LADG group (160.2±85.9mlvs257.8±151.0ml, P<0.01), and there were 13cases (24.1%) need transfusion in ODG group and1case (1.9%) need transfusion in LADG group. No significant difference was found between LADG and ODG in terms of number of dissected lymph nodes (27.9±7.8vs27.7±10.1) and proximal resection margins (3.6±1.9vs4.4±2.1cm). The incidence of postoperative complications in LADG group was significantly lower than that in ODG group(13%vs24.1%, P<0.05).First flatus time(3.9±1.4d vs4.4±1.5d), first liquid diet time (4.6±1.2d vs5.6±2.1d), first semiliquid diet time (6.0±1.7d vs7.4±2.4d), post operative hospital stay (9.5±2.7d vs11.1±4.1d) were significantly shorter in the LADG group than in the ODG group(P<0.05). The mean follow up was60months (range5-97). In Laparoscopic Group the1-,3-,5-and7-year tumor free survival rate was94.3%,90.2%,76.7%and76.7%and in Open Group was89.5%,84.7%,82.3%and78.9%.Survival rates between the two groups had no significant difference(P>0.05). Disease related survival rates between the two groups also had no significant difference between the two groups(P>0.05).Conclusions:Laparoscopy-assisted distal gastrectomy (LADG) for gastric cancer is not significantly different with open surgery in postoperative survival rate and recurrence.LADG is safe and effective.It is less traumatic and of fewer complications.