A Comparison Study Of Short And Long-term Outcomes Between Laparoscopy Gastrectomy And Open Gastrectomy For Advanced Gastric Cancer

Objective To evaluate technical feasibility and oncologic efficacy oflaparoscopy-assisted gastrectomy(LAG) and total laparoscopic gastrectomy(TLG) withD2lymph nodes dissection for advanced gastric cancer.Methods Patients of advanced gastric cancer underwent TLG, LAG or opengastrectomy(OG) with D2lymph nodes dissection in Xijing Hospital between September2005to December2011were recruited for clinical data collecting and follow up. Clinicaldata were recorded and compared between the LAG and OG group, LAG and TLG group.All of the patients were followed up every3to6months by telephone interview, mailsuvery or reexamination. A trained nurse was responsible for the data collecting of follow-up. Clincal data of operation time, intraoperative blood loss, tumor margins status, lymphnodes harvested, postoperative gastrointestinal function recovery time, postoperativeanalgesics time, complications, tumor recurrence rate, disease-free survival rate and overall survival rate in different groups were analyzed.Results Clinical data of1327patients including893in OG,367in LAG and67in TLGwere analysed. Of all the patients, there was no operation death. In the367patientsundergoing laparoscopy-assisted gastrectomy，there were38patients for proximalgastrectomy,144patients for distal gastrectomy and185patients for total gastrectomy,compared with131,328and434in OG group respectively. The mean of operative timewas longer in LAG than OG (286.7±71.9min vs.200.2±63.8min, t’=20.03，P<0.05). Theestimated blood loss was significantly less in LAG group than OG group (251.0±185.7mlvs.288.8±183.8ml, t=3.31, P<0.05)．The iv narcotic use in LAG group was shorter thanin OG (29.8±7.1h vs.57.3±8.5h, t’=58.86, P<0.05). The number of lymph nodesretrieved was20.4±9.9in LAG,19.9±11.2in OG (t’=0.78, P>0.05). All of resectedmargins were free tumor in both groups.34patients had the postoperative complicationsin LAG,81patients in OG, there was no significant differences in postoperativecomplications (9.3%vs9.1%,2=0.00，P>0.05). Length of postoperative stay wassignificantly shorter in LAG than OG (8.6±4.1d vs.9.5±3.9d, t=3.67, P<0.05). Thedisease-free survival rate (DFS) were comparative52.1%in LAG vs47.8%in OG(2=3.77，P>0.05) between two groups.There were29patients for distal gastrectomy and38patients for total gastrectomy inTLG group, while LAG group of262cases, there were102patients for distal gastrectomyand160patients for total gastrectomy. The operation time in TLG was significantly longerthan in LAG (329.1±46.6min vs.278.5±66.3min, t’=7.22, P<0.05). The iv narcotic use inTLG group was shorter than in LAG group (13.4±5.8h vs.23.5±6.4h, t=11.74, P<0.05).As compared with LAG group, there were earlier recovery of bowel activity (3.5±0.6d vs.4.0±1.0d, t’=5.00, P<0.05), and shorter postoperation hospital stay (7.0±1.6d vs.8.0±3.8d, t’=3.27, P<0.05) in TLG group.7cases had the complications in TLG group and23inLAG after an average of31months follow-up（2=0.03, P>0.05）. The5-year DFS ratewere comparative56.4%in TLG vs59.9%in LAG (2=1.18, P>0.05) between twogroups.Conclusion Our results suggested that both of LAG and TLG for advanced gastric cancer are safety and feasibility in terms of surgical outcome and oncologic adequacy. Theoperation time and postoperative complication are acceptable for TLG.