| Chapter.1 Comparative study between laparoscopy-assisted total gastrectomy and open total gastrectomy for advanced gastric cancerObjection:Comparative analysis the safety and effectiveness of laparoscopy-assisted total gastrectomy(LTG)with traditional open total gastrectomy for locally advanced gastric cancer patients.Methods and materials:Locally advanced gastric cancer patients patients who underwent total gastrectomy between January 2008 and July 2013 were analyzed retrospectively,of which 137 patients underwent LTG and 68 patients underwent open total gastrectomy(OTG).Both of two groups made matching 1:1 analysis at the same time,and then we got 51 cases of laparoscopic group and 51 cases of open group from the above information.Patients’ surgical outcomes were compared between the two groups.Results:Compared with open total gastrectomy group,laparoscopic total gastrectomy group were significantly better in intraoperative blood loss、postoperative time and the first diet time(P<0.05),the matched groups got the same result.The incidence of incision problem occured in open group was obviously higher than that in laparoscopic group,wih statistically significant difference(P=0.008).The incision complication in the matched open group and laparoscopic group had no statistical significance(P=0.308).The laparoscopic and laparotomy group patients,who were studied by matched-pair analysis,showed no obvious significant difference at the aspects of 3-year accumulated disease-free survival and accumulated overall survival rate(P>0.05).Chapter.2 Comparative study between laparoscopy-assisted total gastrectomy and open total gastrectomy for advanced gastric cancer patients aged 60 years or moreObjection:This paper retrospectively analysis the safty and effectiveness of laparoscopy-assisted total gastrectomy for advanced gastric cancer patients aged 60 years or more.Methods and materials:A total of consecutive gastric cancer patients who underwent total gastrectomy between June 2009 and November 2012 were analyzed retrospectively.Accrording to the different surgery styles,patients with age 60 years or more as laparoscopy group 68 cases and laparotomy group 41 cases,operative and oncologic outcomes were analyzed of each group.Results:Compared with laparotomy group,laparoscopy group were significantly less in intraoperative blood loss(P=0.025).The incidence of complication between two groups were no statistical significance(P=0.801).The incidence of incision complication in laparoscopy group were significantly less than that in laparotomy group(P=0.045).The rates of accumulated disease-free survival and overall survival between laparoscopy group and laparotomy group were no statistical significance(P>0.05).Chapter.3 Comparison of laparoscopy-assisted total gastrectomy for advanced gastric cancer patients in different age groupsObjection:This study was aimed to compare the safety and oncologic outcomes of elderly patients with nonelderly patients who underwent LTG for advanced gastric cancer(AGC).Methods and materials:Advanced gastric cancer patients who underwent laparoscopic-assisted total gastrectomy were analyzed retrospectively.Among those patients,68 patients aged 60 years or more(elderly group)and 80 patients aged 59 years or less(nonelderly group).Postoperative complications and oncologic outcomes were compared between the two groups.Results:Although the elderly group suffered more by pneumonia than the nonelderly group(P=0.044),the two groups shared similar total postoperative complications(P=0.668).The 3-year disease-free survival(DFS)rate and the 3-year overall survival(OS)rate between the two groups were no obvious significant difference(P>0.05).Multivariate analyses revealed that undifferentiated histology and TNM stage III were independent risk factors for RFS and OS.Based on the above study,we could draw the following conclusions:1.It was safey and feasible for advanced gastric cancer patients who underwent laparoscopic-assisted total gastrectomy,and got the same outcomes compared with laparotomy total gastrectomy.What’s more,it was suitable for advanced gastric cancer patients aged 60 years or more.2.1t was revealed that undifferentiated histology and TNM stage III were independent risk factors for DFS and OS. |
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