背景:三维(3D)腹腔镜技术已逐渐应用于残胃(CRS)癌的治疗。但其临床疗效仍存在争议。
目的:比较3D腹腔镜辅助胃切除术(3DLAG)与开腹胃切除术(OG)治疗CRS的近期和远期效果。
方法:回顾性收集2016年1月至2021年1月解放军总医院第一医学中心收治的CRS患者的临床资料。共纳入84例符合纳入和排除标准的患者。收集他们的所有临床数据并建立数据库。所有患者均由经验丰富的外科医生进行3DLAG或OG治疗,并根据上述手术方法的不同分为两组。通过使用门诊和电话随访,我们能够确定术后生存率和肿瘤状态.比较两组患者术后近期疗效及1年和3年总生存率。
结果:在84例CRS患者中,48用OG处理,36用3DLAG处理。所有患者均顺利完成手术。两组在年龄方面无显著差异,性别,身体质量指数,ASA得分,初始疾病状态(良性或恶性),初级外科吻合方法,癌变的间隔时间,和肿瘤发生部位。3DLAG组患者术中出血量较少(188.33±191.35mLvs305.83±303.66mL;P=0.045),切口较小(10.86±3.18cmvs20.06±5.17cm;P<0.001)。3DLAGC是一种更微创的方法。3DLAGC检索到的淋巴结明显多于OG(14.0±7.17vs10.73±6.82;P=0.036),而阳性淋巴结的数量在两组之间没有差异(1.56±2.84vs2.35±5.28;P=0.413)。两组的并发症发生率(8.3%vs20.8%;P=0.207)和重症监护病房入院率(5.6%vs14.5%;P=0.372)相当。在术后恢复方面,3DLAGC组的视觉模拟评分较低,胃管和引流管的留置时间较短,早期下床动机的时间更短,术后初始排气和初始软饮食摄入的时间较短,术后住院时间和总住院时间较短,并且有很大的差异,短期疗效较好。OG组1年和3年OS率分别为83.2%[95%置信区间(CI):72.4%-95.6%]和73.3%(95CI:60.0%-89.5%)。3DLAG组的1年和3年OS率分别为87.3%(95CI:76.4%-99.8%)和75.6%(95CI:59.0%-97.0%),分别。然而,两组的1年和3年OS率相似,提示两组的长期生存结果具有可比性(P=0.68).
结论:与OG相比,3DLAG用于CRS取得了更好的短期疗效和等效的肿瘤学结果,而不增加临床并发症。在选定的患者中,CRS的3DLAG可以安全有效地推广。
BACKGROUND: Three-dimensional (3D) laparoscopic technique has gradually been applied to the treatment of carcinoma in the remnant stomach (CRS), but its clinical efficacy remains controversial.
OBJECTIVE: To compare the short-term and long-term results of 3D laparoscopic-assisted gastrectomy (3DLAG) with open gastrectomy (OG) for CRS.
METHODS: The clinical data of patients diagnosed with CRS and admitted to the First Medical Center of Chinese PLA General Hospital from January 2016 to January 2021 were retrospectively collected. A total of 84 patients who met the inclusion and exclusion criteria were enrolled. All their clinical data were collected and a database was established. All patients were treated with 3DLAG or OG by experienced surgeons and were divided into two groups based on the different surgical methods mentioned above. By using outpatient and telephone follow-up, we were able to determine postoperative survival and tumor status. The postoperative short-term efficacy and 1-year and 3-year overall survival (OS) rates were compared between the two groups.
RESULTS: Among 84 patients with CRS, 48 were treated with OG and 36 with 3DLAG. All patients successfully completed surgery. There was no significant difference between the two groups in terms of age, gender, body mass index, ASA score, initial disease state (benign or malignant), primary surgical anastomosis method, interval time of carcinogenesis, and tumorigenesis site. Patients in the 3DLAG group experienced less intraoperative blood loss (188.33 ± 191.35 mL vs 305.83 ± 303.66 mL; P = 0.045) and smaller incision (10.86 ± 3.18 cm vs 20.06 ± 5.17 cm; P < 0.001) than those in the OG group. 3DLAGC was a more minimally invasive method. 3DLAGC retrieved significantly more lymph nodes than OG (14.0 ± 7.17 vs 10.73 ± 6.82; P = 0.036), whereas the number of positive lymph nodes did not differ between the two groups (1.56 ± 2.84 vs 2.35 ± 5.28; P = 0.413). The complication rate (8.3% vs 20.8%; P = 0.207) and intensive care unit admission rate (5.6% vs 14.5%; P = 0.372) were equivalent between the two groups. In terms of postoperative recovery, the 3DLAGC group had a lower visual analog score, shorter indwelling time of gastric and drainage tubes, shorter time of early off-bed motivation, shorter time of postoperative initial flatus and initial soft diet intake, shorter postoperative hospital stay and total hospital stay, and there were significant differences, showing better short-term efficacy. The 1-year and 3-year OS rates of OG group were 83.2% [95% confidence interval (CI): 72.4%-95.6%] and 73.3% (95%CI: 60.0%-89.5%) respectively. The 1-year and 3-year OS rates of the 3DLAG group were 87.3% (95%CI: 76.4%-99.8%) and 75.6% (95%CI: 59.0%-97.0%), respectively. However, the 1-year and 3-year OS rates were similar between the two groups, which suggested that long-term survival results were comparable between the two groups (P = 0.68).
CONCLUSIONS: Compared with OG, 3DLAG for CRS achieved better short-term efficacy and equivalent oncological results without increasing clinical complications. 3DLAG for CRS can be promoted safely and effectively in selected patients.