ABSTRACT
Objective?To investigate the effects of laparoscope assisted total gastrectomy (LATG) and open total gastrectomy (OTG) combined with D2 dissection in the treatment of upper gastric cancer and the impact on stress response.?Methods?145 patients with upper gastric cancer who underwent total gastrectomy from June 2014 to June 2017 were selected as research subjects, and they were divided into study group (treated by LATG, n = 70) and control group (treated by OTG + D2 dissection, n = 75) according to different surgical methods. The general condition of surgery, stress indexes cortisol (Cor), C reactive protein (CRP), postoperative recovery and the incidence of complications were compared between the two groups.?Results?The surgical time of the study group was longer than that of the control group, while the length of incision, intraoperative blood loss and length of hospital stay were shorter/less than those of the control group (P < 0.05). There was no significant difference in the number of dissected lymph nodes between the two groups (P > 0.05). Serum Cor and CRP levels in the study group were lower than those the control group during surgery and at 3 d after surgery (P < 0.05). The initial exhaust time and recovery time of liquid diet in the study group was shorter than that in the control group (P < 0.05), but there was no significant difference between the two groups in the rate of second surgery and readmission rate within 30 days (P > 0.05). The incidence of complications in the study group at 6 months after surgery was lower than that in the control group (P < 0.05).?Conclusion?Compared with OTG and D2 dissection, LATG has advantages of less trauma, earlier exhaust and feeding and fewer stress reactions, with quick recovery and few complications.
ABSTRACT
PURPOSE: There is still debate regarding the suitability of extension of laparoscopic gastrectomy to advanced gastric cancer. Due to the development of new instruments and techniques, several studies are being conducted to extend the range of laparoscopic gastrectomy. This study was conducted to investigate the appropriateness of laparoscopic D2 lymph node dissection for the treatment of gastric cancer from an oncology perspective. METHODS: A total of 109 patients, 50 of whom had undergone laparoscopy assisted distal gastrectomy (LADG) and 59 patients who underwent open distal gastrectomy (ODG), that were operated on by a single surgeon in the surgery department of Sanggye Paik Hospital from April 2009 to May 2011 were analyzed. All patients underwent D2 lymph node dissection. The clinical characteristics of patients, surgical outcomes and clinicopathologic findings were then compared and analyzed. RESULTS: There was no significant difference in the operation time between the two groups (252.70+/-40.81 vs. 252.20+/-45.22, p=0.698). The day 1 post operation hemoglobin was higher in the LADG group than the ODG group (12.52+/-1.53 vs. 10.54+/-1.57, p=0.011). There were nosignificant differences in resection margin (6.89+/-2.25 vs. 7.20+/-3.42, p=0.254, 4.05+/-2.57 vs. 3.68+/-2.74, p=0.254) or total number of harvested lymph nodes (30.36+/-10.67 vs. 35.44+/-12.56, p=0.508) between groups. CONCLUSION: In stomach cancer surgery, both ODG and LADG can be used to conduct lymph node dissection. Therefore, if the stability and feasibility of LADG is confirmed by prospective studies at multiple centers, laparoscopic gastrectomy may be extended to advanced gastric cancer as well.
Subject(s)
Humans , Gastrectomy , Hemoglobins , Laparoscopy , Lymph Node Excision , Lymph Nodes , Stomach NeoplasmsABSTRACT
PURPOSE: We compared the clinical results of paraaortic lymph node dissection (PALD) with those of D2 to evaluate the survival gain and disadvantage of paraaortic lymph node dissection for advanced gastric cancer. MATERIALS AND METHODS: We analysed the clinical data of 196 patients who underwent curative resection and D2 with or without paraaortic lymph node dissection (PALD or D2) for advanced gastric cancer from May 1990 to June 1999. The operative factors (operative time, the amounts of intraoperative transfusion and hospital stay), operative morbidity and mortality and 5 year survival rates were compared between D2 and PALD groups. RESULTS: The operative time of subtotal gastrectomy was significantly longer in PALD group than D2 group. The operative morbidity rates were 9.2% in D2 group and 10.3% in PALD group. There were 3 operative mortalities in D2 group and none in PALD group. The 5 year survival rates (5YSR's) of stage IB, II, IIIA, IIIB, IV were 88.9%, 92.3%, 30.2%, 24.2%, 28.9% in D2 group and 93.3%, 75.5%, 61.0%, 0%, 0% in PALD group. CONCLUSION: The paraaortic lymph node dissection was a rather safe procedure without significant increase of morbidity and mortality. There was no statistically significant difference in survival in any stage of this retrospective study with limited cases and follow-ups.