| Objective: To evaluate the learning curve of laparoscopic gastrectomy with D2 lymphadectomy for gastric cancer. Meanwhile, to assess the value of the laparoscopic technique before or after the learning curve.Methods: A comparative study was performed in gastrointestinal section of Fujian Provincial Tumor Hospital. 86 cases underwent laparoscopic gastrectomy with D2 lymphadectomy between Mar 2006 and Dec 2009 which operated by one chief surgeon were collected to deduce the learning curve. Next, 100 cases underwent open D2 radical gastrectomy were collected to compare with the laparoscopic procedure in operative time, blood loss, length of abdominal incision, time to flatus, complications, hospital stay, number of lymph node retrial,recurrence and survival.Results: The learning curve of laparoscopic D2 radical gastrectomy is approximately 40 cases. Before learning curve, the operative time of laparoscopic procedure was longer than that of the open group(p<0.05). After learning curve, the operative time was no significant difference between the laparoscopic and open procedure(P>0.05). Estimated blood loss, length of abdominal incision, time to flatus and take soft diet in laparoscopic group were less than that in open group(P<0.05)whether before or after learning curve. there were no significant difference between two groups in number of lymph node retrieval, complications, hospital stay, recurrence and survival. Conclusions: In spite of being time-consuming before learning curve as compared with open surgery, laparoscopy-assisted radical gastrectomy with D2 lymphadectomy does have merit of safe, effective and less inasie. After learning curve, laparoscopy surgery isn't time-consuming without compromising lymph node dissection by experiencd surgeron. laparoscopic procedure can achieve the same good short-term result as open procedure,and the long-term outcome remains further research. |
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