ABSTRACT
Objective To investigate the effect of short-term complications after D2 radical gastrectomy on long-term survival rate of gastric cancer patients. Methods A retrospective case-control study was conducted on 421 patients with gastric cancer who underwent D2 radical gastrectomy. According to the short-term postoperative complications, they were divided into experimental group (complication group, n=76) and control group (without complication group, n=345). In order to reduce the selection bias, the long-term survival rate of the two groups was tested by Kaplan-Meier survival analysis method after balancing the variables by propensity score matching (PSM). Log rank method was used for univariate analysis and Cox multivariate analysis was used for prognostic factors. Results There was no significant difference in long-term survival rate between the experimental group and the control group (P > 0.05). Histological type, lymph node metastasis rate and pTNM stage were independent risk factors for long-term survival. Conclusion The short-term complications after D2 radical gastrectomy have no significant impact on the long-term survival rate of gastric cancer patients, but it has certain clinical significance to actively prevent and control complications.
ABSTRACT
Primary lesion removal and lymph node dissection are the main constituents of radical gastrectomy. However, the high recurrence rate after D2 radical gastrectomy for advanced gastric cancer has not improved. Recently, studies have found that discrete tumor deposits in the mesogastrium may be an important factor affecting the prognosis of gastric cancer after surgery. With the development of laparoscopic equipment, the ever-expanding "submicroscopic vision" makes it possible to completely remove the mesogastrium. Professor Gong Jianping advocated "membrane anatomy" to optimize the concept of radical gastrectomy: D2- based complete mesenteric resection (CME), namely D2+CME procedure. To prevent the leakage of tumor cells into the surgical field, as histological barrier, the intact mesogastrium should be located. The essential difference between D2+CME and previous D2/D2+systematic mesogastrium excision (SME), en-bloc mesogastric excision (EME) is as follow: double-factor guiding (lymph nodes and discrete tumor deposits) vs. single factor guiding (lymph nodes only). After practicing dozens of radical gastrectomy (D2+CME) authors believe that its conceptual connotation (double factor guiding) and operational extension (above mesentery bed) cover D2. In D2+CME surgery, depending on the anatomical identification under the magnified field of view, the conformal space between gastric mesentery and mesenteric beds is unique operational plane with repeatability. These findings and considerations address one problem: where is the precise boundary of en bloc principle in radical gastrectomy? In author′s opinion, with laparoscopy and "sub-microsurgery" progression and detection of discrete tumor deposit metastasis, survival benefit from definition of en bloc boundary in radical gastrectomy will be widely recognized. Meanwhile, D2+CME procedure is an appropriate way for study. Although the development of the "membrane anatomy" concept for gastric cancer still requires many further clinical and basic researches, it is reasonable to foresee that D2+CME surgery will guide a concept-optimized era for gastric cancer surgery.
ABSTRACT
Objective To investigate the safety and efficacy of laparoscopy-assisted D2 radical gastrectomy in the treatment of advanced gastric cancer.Methods From March 2011 to March 2016,one hundred and four cases treated with LAG for advanced gastric cancer in the general surgery department of Gaochun District People Hospital of Nanjing and the 251st Hospital of PLA were collected in the laparoscope group,104)and 101 cases undergoing gastric cancer surgery from the same period were selected as the control group(open surgery group).A retrospective analysis was performed between the two groups in operation time, intraoperative blood loss, postoperative eating time, ambulation time, exhaust time, postoperative fever, postoperative analgesic use,hospitalization time,postoperative complications,the proximal and distal margins and the number of lymph node dissection.Results The operation time was significantly longer in the LAG group than in the open surgery group(311.2 ± 28.9)min vs.(157.38 ± 11.9)min,t=2.899,P<0.01).The intraoperative blood loss in the laparoscope group was less than that in the open surgery group((100.3±12.1) ml vs.(200.6±16.3)ml,t=3.014,P<0.01).In addition,the frequency of postoperative analgesia,the first postoperative exhaust time,the first postoperative eating time and the postoperative hospital stay in the laparoscopic group were better than those in the open surgery group(P<0.05).There was no significant difference in the number of lymph node dissection and postoperative complication between the two groups(P=0.264,P=0.575).The survival analysis showed that the overall survival rate in the two groups was equivalent at 6 years after surgery(P=0.623).Conclusion Laparoscopy-assisted radical gastrectomy for advanced gastric cancer is safe and feasible,with acceptable long-term results,and shows better performance in the near future.
ABSTRACT
Objective To investigate the safety and efficacy of laparoscopy-assisted D2 radical gastrectomy in the treatment of advanced gastric cancer.Methods From March 2011 to March 2016,one hundred and four cases treated with LAG for advanced gastric cancer in the general surgery department of Gaochun District People Hospital of Nanjing and the 251st Hospital of PLA were collected in the laparoscope group,104)and 101 cases undergoing gastric cancer surgery from the same period were selected as the control group(open surgery group).A retrospective analysis was performed between the two groups in operation time, intraoperative blood loss, postoperative eating time, ambulation time, exhaust time, postoperative fever, postoperative analgesic use,hospitalization time,postoperative complications,the proximal and distal margins and the number of lymph node dissection.Results The operation time was significantly longer in the LAG group than in the open surgery group(311.2 ± 28.9)min vs.(157.38 ± 11.9)min,t=2.899,P<0.01).The intraoperative blood loss in the laparoscope group was less than that in the open surgery group((100.3±12.1) ml vs.(200.6±16.3)ml,t=3.014,P<0.01).In addition,the frequency of postoperative analgesia,the first postoperative exhaust time,the first postoperative eating time and the postoperative hospital stay in the laparoscopic group were better than those in the open surgery group(P<0.05).There was no significant difference in the number of lymph node dissection and postoperative complication between the two groups(P=0.264,P=0.575).The survival analysis showed that the overall survival rate in the two groups was equivalent at 6 years after surgery(P=0.623).Conclusion Laparoscopy-assisted radical gastrectomy for advanced gastric cancer is safe and feasible,with acceptable long-term results,and shows better performance in the near future.
ABSTRACT
Gastric cancer is one of the high incidence of malignant tumors in China,the incidence of which is in the second among the world and is only inferior to Japan.But the mortality of gastric cancer in China is 2 times of world's average level,which is often associated with low early diagnostic rate,big regional differentials in the surgical quantity of gastric cancer (especially D2 radical gastrectomy) and prognosis of patients influenced by surgical quantity.Therefore,a standardized treatment of gastric cancer is the current development trend and hotspot.The correct and programmed staging,evaluation,operation methods,approaches,lymph node dissection and digestive tract reconstruction are selected,thus improving the long-term survival of patients with advanced gastric cancer and reducing mortality in China.