| Purpose: The study is to prove the safety,efficacy,clinical outcomes after laparoscopy-assisted radical gastrectomy(LARG)for gastric cancer and to compare the alterations of immune function after laparoscopic-assisted and open radical gastrectomy (ORG) for gastric cancer. Method: (1) 80 Patients were underwent radical gastrectomy,50 cases laparoscopically and 30 cases openly from march 2004 to april 2005. Among all 50 cases who underwent LARG, 5 cases had radical total gastrectomy(TG),11 cases proximal gastrectomy (PG),3 cases proximal gastrectomy combined with splenectomy and the other 31 cases distal gastrectomy(DG). Among all 30 cases who underwent ORG,3 cases had radical total gastrectomy, 7 cases proximal gastrectomy,2 cases proximal gastrectomy combined with splenectomy and the other 18 cases distal gastrectomy.The parameter observed including:something about operation,postoperative recovery,pathologic examining and the prognosis.(2) 42 Patients, blood samples from 80 gastric cancer patients(22 LARG cases and 20 ORG cases)were detected at 1 day preoperatively and 2 day,1 week,2 week postoperatively. Flow cytometry was used to exploit the phenotypes of T lymphocyte subsets(CD3 + ,CD3 + CD4 + ,CD3 + CD8 + ) and NK cells( CD3 -CD16 + 56 + ). Results: (1)In LARG group:48 procedures out of 50 in LARG were completed laparoscopically with 2 cases of conversion to open surgery.The average operative time for total gastrectomy,proximal gastrectomy,proximal gastrectomy combined with splenectomy,distal gastrectomy was 393.75 ±51.38min(325-490min),293.9 ±62.0min(212-375min),388.33 ±64.29min(315-435min)and 333.47 ±43.51min(255-437min)respectively. The average blood loss in total gastrectomy,proximal gastrectomy, proximal gastrectomy combined with splenectomy,distal gastrectomy was 425.00 ±340.34 ml(100-900ml),186.36 ±102.69ml(50-400ml),333.33 ±115.47ml(200-400ml), 151.00±84.08ml(50-450ml)respectively. The average retrieved lymph nodes in total gastrectomy,proximal gastrectomy,proximal gastrectomy combined with splenectomy, distal gastrectomy was 25.75 ±11.98(12-41),23.00 ±16.57(8-70),24.33 ±3.51(21-28),20.40 ±8.41(8-36)respectively.The average time for first flatus,for the patients'walking,and for the start of oral liquids was 4.03±1.11 days(1-5.5 days),3.26±1.05 days(1-7 days) and 5.45±1.24 days(3-8 days)after the operations,respectively. The operation related complication occurred in 3 cases: anastomosis bleeding in 1 case,leakage in 2 cases. All patients were alive 1 month to 1 year after the operation,with no cancer recurrences and port-site metastasis except 1 patient who died of intra-peritoneal recurrence. In ORG group:The average operative time for total gastrectomy, proximal gastrectomy,proximal gastrectomy combined with splenectomy,distal gastrectomy was 336.67±42.52 min(320-385min),270.75±141.24min(170-480 min), 360.00±106.07 min(285-435 min)and 317.50±83.03 min(165-440 min)respectively. The average blood loss in total gastrectomy,proximal gastrectomy,proximal gastrectomy combined with splenectomy,distal gastrectomy was 450.00 ±132.29ml(350-600ml), 437.50±205.65ml(200-700ml),350.00±212.13ml(200-500ml),354.17±151.45ml(250-800ml)respectively. The average retrieved lymph nodes in total gastrectomy,proximal gastrectomy,proximal gastrectomy combined with splenectomy,distal gastrectomy was 26.33 ±4.04(22-30),18.75 ±7.46(8-25),21.50 ±3.54(19-24),20.00 ±11.39(8-36) respectively. The average time for first flatus,for the patients'walking,and for the start of oral liquids was 5.02±1.04 days(4-7 days),4.31±1.21 days(3-7 days) and 6.12±1.33 days(4-9 days)after the operations,respectively. The operation related complication occurred in 1 cases: peristalsis disability of the gastric remnant. All patients were alive 1 month to 1 year after the operation,with no cancer recurrences and metastasis except 1 patient who died of hepatic metastasis.(2) At the second postoperative day,CD3 + ,CD4 +,NK and the ratio of CD4+/ CD8+significantly decreased comparing to preoperative level in two groups(p<0.05),but there was no statistic difference between two groups(p> 0.05). CD3 +,CD4 +,NK and the ratio of CD4+/ CD8+ returned to preoperative level rapidly in Laparoscopic groups at 1 week postoperatively,but they were still low at 1 week and returned to preoperative level at 2 week postoperatively in open group.The parameter above in open group was all significantly lower than those in Laparoscopic group at 1 and 2 week postoperatively (p<0.05).Conclusions:Laparoscopy-assisted radical gastrectomy is safe, feasible, minimally invasive,and lesser depression to the immune system.It can achieve the same curative result as open surgery.The patients after LARG remains to be investigated. |
