| Background: Gastric cancer is one of the most common malignancies in the gastrointestinal system,and its incidence and death rate is one of the highest,which brings a great burden to our health and economic system.Therefore,research related to the treatment of gastric cancer is of great importance for people’s livelihood.Since Kitano first applied laparoscopy in the treatment of early gastric cancer in 1994,much evidence based on evidence has proved that laparoscopic surgery is feasible and safe in the early stage of gastric cancer.Since then the technology of laparoscopic treatment of gastric cancer has rapidly developed.In Europe,the United States,Japan and South Korea,early gastric cancer accounts for the majority.However,in developing countries such as China,due to the difficulty of popularization of gastroscopic screening technology,it is often in progress at the time of discovery.In 2009,the Chinese Laparoscopic Gastroenterological Surgery Research Group(CLASS Research Group)was established under the organization of gastrointestinal minimally invasive surgery experts.The research group has carried out the CLASS-01 study.Japan In 2010 and 2011,South Korea also carried out a large multicenter prospective clinical study JLSSG0901 and a multicenter prospective phase III clinical study KLASS-02-RCT for laparoscopic distal gastrectomy in locally advanced gastric cancer.These large multi-center clinical trials have provided a large amount of evidence-based medical evidence for the application of laparoscopic technology to advanced gastric cancer.However,there have been few clinical studies on stage T4 a gastric cancer that invaded the serous layer or even the whole layer,and the efficacy of laparoscopy for stage T4 a gastric cancer has been controversial.The controversy is whether laparoscopic D2 lymph node dissection is thorough,whether laparoscopy will cause tumor spread and affect prognosis.In recent years,studies on the application of laparoscopic D2 lymph node dissection in stage T4 a gastric cancer have been gradually carried out,but most of them are retrospective studies with small sample size,with research bias,and lack of multicentre prospective studies with high evidence level.Therefore,the propensity score was used in this study to reduce the deviation,which is of great clinical significance for the study on the comparison of the short-term efficacy of laparoscopic and open D2 lymph node dissection to provide clinical basis for the laparoscopic treatment of stage T4 a gastric cancer with serosa invasion and theoretical basis for future prospective studies.Objective: For patients with stage T4 a gastric cancer,the efficacy of laparoscopic versus open surgery has been controversial.The purpose of this study was to investigate the short-term efficacy of laparoscopic-assisted D2 radical operation for stage T4 a gastric cancer,and to compare it with open surgery,in order to provide theoretical basis for the application of laparoscopic surgery in stage T4 a gastric cancer.Methods: The data of patients diagnosed with T4 a stage gastric adenocarcinoma and undergoing D2 lymph node dissection admitted to the Department of Gastrointestinal Surgery,Affiliated Hospital of Yan ’an University from January 2014 to December 2020 were retrospectively analyzed by using the propensity score matching study method.According to the surgical methods,the patients were divided into the open group(362cases)and the laparoscopic group(134 cases).The statistical method of propensity score matching was adopted to match the data 1:1,and the matching tolerance was set to 0.03.Finally,each of the two groups of cases 134 was obtained.The operation conditions(number of lymph nodes dissection,operation time,postoperative eating time,postoperative hospital stay,etc.),postoperative complications(intestinal obstruction,bleeding,nausea and vomiting,pulmonary complications,etc.),postoperative inflammatory indicators(NLR,PLR,LMR)and 2-year overall survival rate of the two groups were compared.Results: After tendency matching,the baseline data of laparoscopy group and laparotomy group were comparable(all P>0.05).There was no statistical significance in the time of first postoperative feeding and postoperative hospital stay in 2 groups(P>0.05).The operation time of 240min(203.75,256.25)in the laparoscopic group was longer than that in the laparotomy group 140min(120,190),and the incision length of5cm(5,6)in the laparoscopic group was shorter than that of 12cm(10,15)in the laparotomy group.The postoperative discharge time was 4 days(3,6)shorter in laparoscopic group than 5 days(3,6),and 2 days(2,3)in laparoscopic group,compared with 3 days(2,3)in laparotomy group.The intraoperative blood loss of 200ml(100,300)in the laparoscopic group was less than that in the laparotomy group(200ml(200,300),with statistical significance(P<0.05).The number of lymph node dissection was 20.5(17,27.25)more than 16(10,23)in laparoscopic group.The difference was statistically significant.There were no significant differences in postoperative complications(P >0.05).The results showed that NLR,PLR,LMR had no statistical significance(P >0.05).There was no significant difference in PLR after operation,but there was significant difference in NLR and LMR after operation.Among them,NLR is the risk factor of prognosis,and LMR is the protective factor of prognosis.The results showed that NLR and LMR in laparoscopy group were lower than those in laparotomy group,and LMR were higher than those in laparotomy group.The 2 year OS was 53.3% and48.3% in the laparoscopic group.There was no significant difference between them(P =0.211).Conclusion: The incidence of postoperative complications and 2-year survival rate in the laparoscopic group were similar to those in the open group,but the laparoscopic group had the advantages of less trauma,less bleeding and faster postoperative recovery.The long-term effect needs further research and exploration. |
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