Comparison Of Pain And Anxiety Between Laparoscopy-Assisted Gastrectomy And Open Gastrectomy

[Background]China is classified as a high incidence area for gastric cancer which has the most newly diagnosed cases every year in the world. Surgery is the cornerstone in the treatment of gastric cancer which includes conventional open gastrectomy (OG) and laparoscopy-assisted gastrectomy (LAG). Laparoscopy-assisted gastrectomy is reported to cause little pain and anxiety, which is one of its major advantage. However, because pain is a subjective experience, most of the studies are indirectly indicated by the total number of analgesics used during postopeartive period, so the final outcome is inclined to be disturbed by the different anesthesia and pain sensitivity among the partients. A direct and objective study for the assessment of pain is in need. Moreover, most of the study of anxiety of gastrectomy are long-term, which can’t reflect the situation in perioperative period.[Methods]Participants of the study are patients after open distal gastrectomy (ODG,20 cases), laparoscopically assisted distal gastrectomy (LADG,19 cases), open total gastrectomy (OTG,18 cases), and laparoscopically assisted total gastrectomy (LATG, 19 cases). The Short-Form McGill Pain Questionnaire(SF-McGill) was used to evaluate the differences in pain. Each patient was evaluated from postoperative day (POD) 1 to POD 3、POD5 and PDO7. The Self-Rating Anxiety Scale(SAS) was used to evaluate the differences in anxiety in Preoperative Day 1 (PROD1) for anxiety during one week Preoperative and POD7 for anxiety during one week Postoperative. Temporal changes in pain and anxiety were studied comparatively between ODG and LADG and between OTG and LATG. At the same time, we also studied and compared the short-term outcomes after surgery between ODG and LADG, as well as OTG and LATG respectively, such as operation time, blood loss,postoperative hospital stay, and postoperative complications, etc.[Results]Peak pain scores were recorded on POD1 for both distal and total gastrectomy. The pain scores decreased over time after POD1. The postoperative pain of LG is significantly lower and decrease earlier. Significant difference were shown on PODs 1、2、3、5 between LADG and ODG and on PODs 1、2、3、5、7 between LATG and OTG.The same preoperative anxiety scores were shown between LAG and OG, which belongs to the mild anxiety degree. But LAG shows significantly lower postoperative anxiety score. The same characteristics were observed with both LADG and LATG. When performed laparoscopically, distal and total gastrectomy both required significantly longer operation time but resulted in significantly reduced blood loss and length of postoperative hospital stay and had the same number of lymph nodes dissected an open gastrectomy. The same characteristics were observed with both LADG and LATG.[Conclusions]Laparoscopic-assisted gastrectomy has affirmed short-term outcomes, but its long-term outcome still need large randomized controlled clinical trials to assess; The postoperative pain of Laparoscopic-assisted gastrectomy is significantly lower and decrease earlier compared with open gastrectomy. Laparoscopic-assisted gastrectomy has no significant difference in the preoperative anxiety aspect versus open gastrectomy, but significantly lower postoperative anxiety is a big advantage of the former.