Abstract: Objective:To compare the effect of laparoscopy-assisted gastrectomy (LAG) and open D₂ radical gastrectomy (OG) for gastric cancer.
Methods:The retrospective cohort study was conducted. The clinicopathological data of 117 patients who underwent D₂ radical gastrectomy at the Guangdong General Hospital from January 2014 to December 2014 were collected. Of 117 patients, 60 undergoing LAG and 57 undergoing OG were respectively allocated into the LAG group and OG group. Total gastrectomy, distal subtotal gastrectomy and proximal subtotal gastrectomy were performed according to the location of the tumor. The perigastric lymph nodes dissection was performed according to the Japanese “Gastric cancer treatment protocol” (the 14th edition). Eligible patients received the adjuvant chemotherapy of XELOX regimen according to the Guideline published by National Comprehensive Cancer Network (NCCN). Observation indicators: (1) comparison of intra- and post-operative recovery between groups; (2) stratified analysis of number of lymph node dissected; (3) relationship among surgical method, number of lymph node dissected and postoperative complication; (4) follow-up and survival. Follow-up using outpatient examination and telephone interview was performed to detect the postoperative adjuvant chemotherapy, tumor-free survival and tumor recurrence or metastasis up to December 2016. Measurement data with normal distribution were represented as ±s and comparison between groups was analyzed using the independent-sample t test. Count data were analyzed using the chi-square test or Fisher exact probability. The relationship between number of lymph node dissected and postoperative complication was done using the Logistic regression model.
Results:(1) Comparison of intra- and post-operative recovery between groups: all the patients completed the operation successfully. Volume of intraoperative blood loss, time to postoperative anal exsufflation and duration of postoperative hospital stay were (113±36)mL, (4.3±2.1)days, (9.7±2.9)days in the LAG group and (209±77)mL, (5.3±2.2)days, (11.2±3.9)days in the OG group, respectively, with statistically significant differences between groups (t=6.850, -2.604, -2.405, P<0.05). Number of lymph node dissected, numbers of patients with overall complication, incisional infection, intestinal obstruction, digestive tract fistula, intra-abdominal bleeding, cardiovascular accident, pulmonary infection, urinary tract infection and death within postoperative 30 days were respectively 31±7, 6, 1, 0, 4, 0, 0, 1, 0, 0 in the LAG group and 34±6, 12, 0, 1, 2, 2, 1, 4, 1, 1 in the OG group, with no statistically significant difference between groups (t=0.177, x²=2.743, 0.126, 0.563, 0.837, P>0.05). All the patients with complications received symptomatic treatment, 1 patient with abdominal bleeding in the OG group died and other patients recovered smoothly. (2) Stratified analysis of number of lymph node dissected: number of lymph node dissected in patients with total gastrectomy, distal subtotal gastrectomy and proximal subtotal gastrectomy were 35±8, 29±5, 27±4 in the LAG group and 34±5, 34±6, 29±6 in the OG group, respectively, with no statistically significant difference between groups (t=0.846, 1.052, 0.934, P>0.05). Number of lymph node dissected in patients with stageⅠ, Ⅱ and Ⅲ of TNM staging were respectively 31±5, 32±9, 31±6 in the LAG group and 34±7, 32±4, 35±6 in the OG group, with no statistically significant difference between groups (t=0.494, 1.657, 0.136, P>0.05). (3) Relationship among surgical method, number of lymph node dissected and postoperative complication: surgical method (LAG and OG) and number of lymph node dissected were used as the independent variable and postoperative complication between groups was used as the dependent variable, the Logistic regression model showed that surgical method and number of lymph node dissected were not related factors affecting the postoperative complication (OR=1.062, 2.049, 95% confidence interval: 0.998-1.140, 0.695-6.042, P>0.05). (4) Follow-up and survival: 108 of 117 patients (54 in each group) were followed up for 2-35 months, with a median time of 28 months. During the follow-up, numbers of patients undergoing postoperative adjuvant chemotherapy, with tumor-free survival and with tumor recurrence were 45, 43, 10 in the LAG group and 42, 42, 10 in the OG group, respectively, with no statistically significant difference in the tumor-free survival and tumor recurrence between groups (x²=0.055, 0.002, P>0.05).
Conclusion:Laparoscopy-assisted D₂ radical gastrectomy is safe and feasible, which equivalent to clinical effect of open radical gastrectomy, meanwhile, it also can reduce volume of intraoperative blood loss and duration of postoperative hospital stay, and accelerate recovery of postoperative gastrointestinal function.