Clinical Application Of Hand-assisted Laparoscopic Techniques In Gastric Carcinoma

Objective To study the clinical application of hand-assisted laparoscopic technique in gastric carcinoma and the curative effect.Methods 1.A retrospective analysis of 77 patients with advanced Siewert type II and III AEG between March 2010 and March 2011 were divided into two groups: the hand-assisted laparoscopic surgery group(HALS)and the open surgery group.Data concerning the basic characteristics of patients,pathological staging,early postoperative course,and long-term follow-up were collected and analyzed.2.105 patients with advanced Siewert type II and III AEG operated in our department from January 2012 to January 2013 were divided into two groups: the hand-assisted laparoscopic surgery group(HALS)and the laparoscopy assisted surgery group(LAS).Data concerning the basic characteristics of patients,pathological staging,early postoperative course,and long-term follow-up were collected and analyzed.3.85 patients suffering distal radical gastrectomy in our department from January 2012 to January 2013 were divided into two groups: the hand-assisted laparoscopic surgery group(HALS)and the laparoscopy assisted surgery group(LAS).Operative time,estimated blood loss,number of lymph node retrieval,Intraoperative blood transfusion,postoperative complications and postoperative hospital stay were compared between the two groups.Results 1.HALS resulted in significantly lower mean blood loss and mean postoperative hospital stay in comparison to open surgery(P=0.011 and 0.01,respectively)for advanced Siewert type II and III AEG.The mean number of resected lymph nodes was 24.16±9.36 in the HALS group,which was more than in the open surgery group(18.97 ± 6.91,P=0.015).The cumulative 5-year overall survival(OS)rate was 55.6%(95% CI 43.07–60.09)for all patients in the HALS group(72.1% for stage II patients and 44.6% for stage III patients).The 5-year OS rate was not significantly different between both groups.2.HALS resulted in significantly shorter operation time and the average postoperative hospital stay(P = 0 and 0.002,respectively)for advanced Siewert type II and III AEG.The cases of HALS group transfer laparotomy is 0,significantly less than laparoscopy assisted surgery group(3 cases,P = 0.042).5 years of overall survival(OS)in HALS group at a rate of 46.7%(95% CI,39.98 to 53.88),with stage II patients was 60.9%,37.8% patients with stage III.5 years OS rate not significantly different between the two groups.3.HALS resulted in significantly shorter operation time was 163.55 minutes than laparoscopy assisted surgery for distal radical gastrectomy,P = 0.In blood loss,intraoperative blood transfusion,the lymph nodes harvested,the number of transfer laparotomy,postoperative complications,etc have no significantly different between the two groups.Conclusion 1.While achieving similar oncological outcomes to open surgery,the HALS approach resulted in reduced blood loss,shortened postoperative hospital stay,and the resection of more lymph nodes.This analysis suggests that HALS may serve as a less invasive and as successful alternative to open surgery for the treatment of advanced Siewert type II and type III AEG.2.HALS compared laparoscopy assisted surgery in the treatment of advanced Siewert type II and type III AEG has shorter operation time,higher safety operation,shorter postoperative recovery time.The number of patients with postoperative complications and the 5-year survival rate after surgery have no significantly different between the two groups.3.HALS on distal gastric cancer radical operation time is shorter than laparoscopy assisted surgery.In blood loss,intraoperative blood transfusion,the lymph nodes harvested,the number of transfer laparotomy,postoperative complications,etc have no significantly different between the two groups.