Comparison Of The Curative Effect Of Laparoscopic And Open Radical Gastrectomy For Advanced Gastric Cancer

Objective: By comparing the clinical efficacy of laparoscopically assisted radical gastrectomy and open radical gastrectomy in the treatment of advanced gastric cancer.To provide more basis for the extensive development of laparoscopic techniques in the radical gastrectomy for advanced gastric cancer.Methods: Carry on the retrospective analysis of the clinical data from the 550 patients diagnosed with advanced gastric carcinoma in Wan Nan Medical College Yijishan hospital from January 2011 to January 2017.The number of the patients underwent the laparoscopically assisted radical gastrectomies is 305.All the operations were performed by the surgical teams with skillful operation technology of laparoscopy.And the number of patients underwent open radical gastrectomies is 245 during the same time.All the patients are divided into four groups according to the surgical approach.Among whom,135 patients accepted the open distal gastrectomy(ODG),165 patients accepted the laparoscopically assisted distal gastrectomy(LADG),110 patients accepted the open total gastrectomy(OTG),140 patients accepted the laparoscopically assisted total gastrectomy(LATG).Consider different methods of operation may impact the statistics and influent the final conclusions,divide the cases underwent distal and total radical gastrectomies into two groups.Then compare the perioperative indicators,hospitalization expenses,specimen qualities,complications,recurrence,metastasis and survival situations between laparoscopically assisted radical gastrectomy and the open ones in each group.Results: The operation time of LADG is more than ODG's(P<0.01).But LADG is better than ODG in various indicators(all P<0.01)such as the incision length,the blood loss in operations,the time of getting out of bed,the first exhaust time,the first time of fluid food,the time of abdominal drainage,the time of hospitalization.The total cost of the LADG is similar to ODG's and there is no significant difference(P>0.05).But the drug occupation ratio of ODG is higher than LADG's and the supply occupation ratio of LADG is higher than ODG's.Differences are statistically significant.There is no statistical significance in the difference between LADG's tumor pathological data and ODG's including the number of lymph node dissection(all P>0.05).It is worth mentioning that LADG cuts off more lymph nodes than ODG in group 14 v,8p,12 p,and the difference has statistical significance.So LADG can get the similar radical effect with ODG and even has advantages with dissection of lymph in some regions.There is no statistical significance in the difference of the rate of complications,reoperation and fatality between LADG and ODG(P=0.990;P=1.000;P=0.450).Through induction and comparison of Clavien-Dindo,the difference still has no statistical significance between the two groups(P=0.530).So we can see laparoscopy group and laparotomy group share the same surgical safety.There is no statistical significance in the difference of recurrence,metastasis and survival situations between LADG and ODG(all P>0.05).We can get the similar result in the group of total radical gastrectomy.The operation time of LATG is more than OTG's(P<0.01).But LATG holds advantages when compared with ODG in various perioperative indicators(all P<0.01).The cost of hospitalization is consistent with the distal radical gastrectomy group.There is no statistical significance in the difference between LATG's number of lymph node dissection and OTG's(P=0.626).But LATG cuts off more lymph nodes than OTG in group 14 v,8p,12 p and splenic hilum region,and the difference has statistical significance(all P<0.01).There is no statistical significance in the difference of complication constitution,recurrence,metastasis and survival situations between LATG and OTG(all P>0.05).Conclusion: Laparoscopically assisted radical gastrectomy is safe and radical by the standards of open radical gastrectomy in the treatment of advanced gastric cancer.Thus it shows the similar curative effect with the open one and it also has minimally invasive advantages such as less blood loss in operations and better postoperative recovery etc.Surgical operations still needs to be standardized clinically.The surgeons should improve the proficiency of the operation.Building more tacit teams is also necessary.