Comparison Of Laparosceopy-Assisted Radical Gastrectomy And Open Radical Gastrectomy In Adanced Cancer

Background:In past twenty years,there were so many creative and innovative reports and improvement about1aparoscopic surgical technique,such as the first success of1aparoscopic cholecystectomy (LC)by Mouret in1987,the first case of laparscopy-assisted distal gastrectomy (LADG)used in early stage gastric cancer by Kitano in1994,the first report about1aparscopy-assisted radical gastrectomy(LARG) for advanced gastric cancer (AGC). Nowadays LRG has been accepted and adopted for gastric cancer in more and more laparoscopic surgical centers. And with the tremendous and innovative progression in1aparoscopic surgical technique system and obvious improvement of surgical experiences, more further studies about LRG were performed. In2007Lee approved the safety and feasibility of LADG with D2lymph node dissection for AGC through a phage Ⅱ clinical research. And there are many studies about the comparison of the operational outcomes of LRG and ORG. LRG with D2lymph node dissection not only have shown oncologic equivalency to the open total gastrectomy (ORG) without increase the ratio of postoperative complication, but have the known benefits of the minimal invasions, better visual horizon, fast recovery etc. However, there were scarcely prospective reports on long-terms outcomes of LARG for AGC, which are related to tumor recurrence rate, long-term survival. Although there were some small-scale fellow-up results regarding LAG can get the adequate long-terms outcomes with that of ORG. the application of LARG for advanced gastric cancer still remains controversial.Research Objectives:A total of61patients with AGC consecutive and nonrandom underwent ARG or ORG between Jun.2011and Dec.2012in our hospital. A retrospective case-control study was performed comparing the general characters and operative outcomes of LARG and ORG for AGC to discuss and evaluate the feasibility, safety and advantages of LARG for AGC.Methods:The clinical data of61AGC patients undergoing LARG (30cases) or ORG (31cases) admitted from Jun.2011to Dec.2012in minimally invasive surgery center of Qilu hospital were retrospectively analyzed. We collected and recorded the general information of patients, operation associated data and postoperative recovery associated data. And then we used certain statistical methods to analysis those data and got results.Results:The total of61available AGC patients who were no-randomized divided into two groups, LARG group with30cases and ORG group with31cases. There are no significant statistical differences between LARG groups and ORG groups in gender, age, weight, tumor diameter and the pathological tumor-node-metastasis stage. LARG groups had significantly longer operative time (LARG258.96±41.82minutes, ORG180.95±61.90minutes, P<0.01) and higher expenditure(LARG44163.62±12942.89Yuan, ORG37658.06±10483.15Yuan. P<0.01), but a less blood loss ((LARG120.68±43.34ml, ORG189.06±79.04ml,P><0.01), shorter scar (LARG6.65±2.22cm, ORG19.37cm±2.51cm, P<0.01), less postoperative pain-killers (LARG3/30, ORG10/31,P=0.04), shorter time for first flatus (LARG4.24±0.83Days, ORG5.03±0.96Days, P<0.01), shorter time to tolerance of soft diet ((LARG8.51±2.86days, ORG10.62±3.79days,P<0.05)and faster postoperative recovery (LARG13.82±3.06Days, ORG17.34±4.37Days, P<0.01). And there are no significant differences between the two groups in the number of lymph node dissection (LARG22.51±6.53, ORG 24.15±7.13, P=0.42). In addition, the total complication rate among30LARG and31ORG was16.6%(5/30)and19.4%(6/31), there was no significant differences between complication rate (P=0.56).Conclusion:LARG has shown oncologic equivalency to the open radical gastrectomy (ORG) without increase the rate of postoperative complications, and has the known benefits of a less blood loss, shorter scar, less postoperative pain-killers, faster postoperative recovery. But LARG takes longer operative time and costs more. Above all, LARG is a feasible, safe, efficient and minimal invasive procedure used in AGC patients. However, more Large-scale prospective randomized studies will be needed to evaluate and support the long-terms outcomes which are relative with the tumor recurrence rate and long-term survival.