PDF(Pubmed)
Abstract：
Background: The short-term and long-term outcomes of laparoscopic-assisted distal gastrectomy (LADG) and totally laparoscopic distal gastrectomy (TLDG) have been subject to controversy with various reconstruction techniques of Billroth-I, Billroth-II, Roux-en-Y, and Uncut. This study aims to compare the short-term and long-term outcomes of LADG and TLDG as well as the outcomes of different anastomoses. Methods: This study enrolled patients with gastric cancer at the First Affiliated Hospital of Nanjing Medical University (NMUH) between 2017 and 2021. Postoperative complications were classified according to the Clavien-Dindo grade. Exclusion criteria included metachronous and synchronous malignancy and palliative surgery. The Kaplan-Meier analysis was applied to assess 5-year prognosis between two groups. Results: This study included 1221 cases with an overall complication rate of 17.37% for LADG, which was significantly higher than TLDG\'s 10.72%. The incidence of anastomosis-related complications was 4.79% for LADG and 1.13% lower for TLDG. LADG and TLDG did not show significant difference for Grade III-V complications and resected lymph nodes. The postoperative stay was shorter for TLDG than LADG, and R-Y had a longer postoperative stay than B-II and Uncut after combining LADG and TLDG. The operation time was shorter in TLDG cases than that in LADG cases. The 5-year OS of the TLDG group was not significantly better than that of the LADG group. Conclusion: TLDG is superior in overall complication rate, anastomosis-related complication rate, postoperative stay and operation time to LADG. No difference of OS was observed between LADG and TLDG. Four anastomoses had no convincing evidence of being superior in complications rates, post-op stay, and harvested lymph nodes to each other.
摘要：
背景：腹腔镜辅助远端胃切除术（LADG）和完全腹腔镜远端胃切除术（TLDG）的短期和长期结果一直受到Billroth-I各种重建技术的争议，Billroth-II,Roux-en-Y,和Uncut。本研究旨在比较LADG和TLDG的短期和长期结果以及不同吻合的结果。方法:选取2017-2021年南京医科大学第一附属医院胃癌患者。术后并发症根据Clavien-Dindo分级进行分类。排除标准包括异时和同步恶性肿瘤和姑息性手术。采用Kaplan-Meier分析评估两组5年预后。结果：本研究纳入1221例LADG患者，总并发症发生率为17.37%，显著高于TLDG的10.72%。LADG吻合相关并发症的发生率为4.79％，TLDG降低1.13％。对于III-V级并发症和切除的淋巴结，LADG和TLDG没有显着差异。TLDG术后住院时间短于LADG,合并LADG和TLDG后，R-Y的术后停留时间比B-II和Uncut更长。TLDG病例的手术时间短于LADG病例。TLDG组的5年OS没有明显优于LADG组。结论：TLDG在总体并发症发生率方面优于TLDG，吻合相关并发症发生率，LADG的术后停留时间和手术时间。在LADG和TLDG之间没有观察到OS差异。四个吻合没有令人信服的证据表明并发症发生率更高，术后逗留,并互相收集淋巴结。
