Abstract: Objective:To investigate the clinical efficacy of laparoscopyassisted radical gastrectomy for gastric cancer.
Methods:The retrospective cohort study was adopted. The clinical data of 210 patients with gastric cancer who underwent laparoscopyassisted radical gastrectomy at the Peking University Cancer Hospital between May 2009 and December 2012 were collected. Fiftytwo, 43 and 115 patients were respectively detected in stage Ⅰ, Ⅱ and Ⅲ of postoperative pathological stage. Laparoscopyassisted radical distal, proximal and total gastrectomies were selectively performed according to the location and extent of tumors. (1) Overall treatment indicators were observed, including surgical procedure, with or without conversion to open surgery, operation time, volumes of intraoperative blood loss and transfusion, number of lymph node dissected, time to anal exsufflation, duration of hospital stay, occurrence of complications, radical degree of tumors of pathological examination. (2) Other indicators were observed, including pathological features of patients in stage Ⅰ, Ⅱ and Ⅲ ［gender, age, body mass index (BMI), scores of American Society of Anesthesiologists (ASA), medicinal complication, location of tumors, degree of tumor differentiation and with or without vascular tumor thrombi］, intraoperative and postoperative situations (surgical procedure, conversion to open surgery, operation time, volumes of intraoperative blood loss and transfusion, number of lymph node dissected, time to anal exsufflation, duration of hospital stay and radical degree of tumors), postoperative complications, reoperation, death within postoperative day 30 and during followup, 3 and 5 year survival rates. (3) Evaluation criteria: stages and classification of tumors were evaluated according to the tumor node metastasis (TNM) classification of malignant tumours (Seventh Edition) published by American Joint Committee on Cancer (AJCC) and Union for International Cancer Control (UICC). Severity of complications was evaluated according to ClavienDindo classification. Patients were followed up by outpatient examination, telephone interview and correspondence once every half a year up to December 31, 2015, abdominal / pelvic CT, chest Xray and blood test were performed once every half a year within 2 years and once every year within ²- 5 years postoperatively, and gastroscopy was performed once every year. Overall survival time was counted from operation date to end of followup or time of death.  Measurement data with normal distribution were presented as ±s and comparison between groups was analyzed using the ANOVA. Measurement data with skewed distribution were presented as M (range) and comparison between groups was analyzed using nonparametric test. Comparisons of count data were analyzed using the chisquare test. Survival curve was drawn by the KaplanMeier method, and survival analysis was done using the Logrank test.
Results:(1) Overall treatment: all the 210 patients underwent successful radical gastrectomy, including 100 undergoing distal gastrectomy, 35 undergoing proximal gastrectomy and 75 undergoing total gastrectomy. There were 198 patients undergoing radical gastrectomy and 12 patients converted to open surgery. Operation time, volume of intraoperative blood loss, number of patients with blood transfusion and number of lymph node dissected were (258±54)minutes, (103±86)mL, 19 and 29±12, respectively. Postoperative recovery: time to anal exsufflation and duration of hospital stay were (3.8±0.9)days and (17±7)days. Fortyfive patients had postoperative complications and 2 were dead within 30 days postoperatively. R0 and R1 resections were respectively applied to 209 and 1 patients. (2) Comparisons among the patients with the different pathological stage: numbers of patients in stage Ⅰ, Ⅱ and Ⅲ were 9, 17 and 36 with tumor located in the upper stomach, 3, 9 and 22 with tumor located in the middle stomach, 40, 16 and 47 with tumor located in the lower stomach, 0, 1 and 10 with tumor located in the crossregion stomach, 30, 23 and 23 in G1 and G2 of tumor differentiation, 21, 19 and 92 in G3 and G4 of tumor differentiation, 7, 13 and 69 with vascular tumor thrombi, respectively, with significant differences in above indicators among the patients in stage Ⅰ, Ⅱ and Ⅲ (χ²= 25.990, 32.928, 35.027, P<0.05). (3) Intra and postoperative comparisons among the patients with the different pathological stage: numbers of patients in stageⅠ, Ⅱ and Ⅲ  were respectively 40, 20 and 40 with distal gastrectomy, 3, 8 and 24 with proximal gastrectomy, 9, 15 and 51 with total gastrectomy, and number of lymph node dissected were 26±9, 29±13 and 31±12 in patients with stage Ⅰ, Ⅱ and Ⅲ, showing significant differences in above indicators among the patients in stage Ⅰ, Ⅱ and Ⅲ (χ²=25.730, F=4.336, P<0.05). (4) Numbers of patients with postoperative overall complications were 11, 8 and 26 in stage Ⅰ, Ⅱ and Ⅲ, showing no significant difference (χ²=0.301, P>0.05). (5) Of 210 patients, 203 were followed up for a median time of 43 months (range, 1-80 months) with a followup rate of 96.67%(203/210).  Sixtyeight patients were dead till the end of followup, including 60 died of recurrence of tumor, 2 died of surgical complications and 6 died of other causes. Postoperative 3, 5 year overall survival rates were 96.1%, 87.8%, 62.4% and 92.9%, 77.5%, 52.7% in patients with stage Ⅰ, Ⅱ and Ⅲ, respectively, with a significant difference (χ²=29.071, P<0.05).
Conclusion:Laparoscopyassisted radical gastrectomy for advanced gastric cancer is at least equivalent to early gastric cancer in the safety, with the satisfactory longterm outcomes.