Comparison About Short-Term Effect Of Totally Laparoscopy Versus Open Radical Total Gastrectomy With D2 Lymph Node Dissection For Local Advanced Upper Gastric Cancer

Objective:To explore short-term effect of Totally Laparoscopic radical total gastrectomy with D2 lymph node dissection for local advanced upper gastric cancer.Methods:Clinical data of the 112 patients suffering local advanced upper gastric cancer who underwent totally Laparoscopic or open radical total gastrectomy with D2 lymph node dissection in Shanxi Province Cancer Hospital from June 2016 to December 2018 were analyzed.Fifty-four patients underwent totally Laparoscopic surgery and fifty-eight underwent open surgery.The datas of surgery and postoperation were analyzed by t test or x~2test.Results:All the 112 operations were technically successful.The operating time of the totally Laparoscopic gastrectomy group(TLTG group)was longer than that of the opening gastrectomy group(OG group)[t=4.939,P<0.05].The estimated blood loss was reduced in TLTG group compared with OG group[t=28.653,P<0.05].The length of operative incision on body surface of TLTG group was shorter than that of OG group[t=6.927,P<0.05].There were no significant differences in the distance between the upper incision edge and tumor about two groups[t=1.264,P=0.074].There were no significant diferrences in the number of excised lymph node between two groups[t=1.726,P=0.098].The pain degree after operation was slighter in TLTG group than OG group(P<0.05).The ratio of postoperative complications was lower in TLTG group than that in OG group[x~2=4.517,P<0.05].The time of intestinal recovery and postoperative hospital stay in TLTG group was shorter than that of OG group(P<0.05),manisfested as first exhaust time after surgery[t=8.429,P<0.05],first defecationtimeaftersurgery[t=18.467,P<0.05],firstmealtimeafter surgery[t=24.978,P<0.05].The postoperative hospital stay time in TLTG group was shorter than that of OG group[t=12.543,P<0.05].The short-term recurrence rate of the two groups was similar after surgery,including half-year cumulitive recurrence rate[x~2=0.417,P>0.05]and one-year cumulitive recurrence rate[x~2=0.002,P>0.05].Conclusion:Totally Laparoscopic radical total gastrectomy with D2 lymph node dissection for local advanced upper gastric cancer has advantages in operation safety,postoperative pain,the time of postoperative gastrointestinal function recovery,postoperative pain and the ratio of postoperative complications.But the operating time of TLTG is exactly longer than OG.It could reach the level in lymph node dissection like open total gastectomy.The recent treatment effects of two surgical methods are equivalent.