Comparison Of Clinical Indexes Between Laparoscopy-assisted And Open Radical Gastrectomy For Advanced Gastric Cancer

Background and ObjectiveThe use of laparoscopic technology in the treatment of early gastric cancer (EGC) has been widely accepted. However, whether laparoscopic technology can be safely applied in advanced gastric cancer(AGC) is still controversial at present. Our aim was to appraise short-term outcomes, surgical trauma, inflammatory and stress responses, impacts on hepatic and renal function after laparoscopy-assisted gastrectomy for AGC.MethodsAccording to inclusion and exclusion criteria,40 cases were enrolled in laparoscopy-assisted gastrectomy(LAG) group and another 40 cases in open gastrectomy(OG) group, receiving laparoscopy-assisted radical gastrectomy and conventional open radical gastrectomy, respectively. The gender, age, BMI, type of resection, operation time, blood loss volume, number of lymph nodes harvested, hospitalization days, complications of enrolled patients were collected. IL-6, TNF-α, CRP, HO-1, WBC, hepatic function indexes (AST, ALT, TBIL, DBIL, PA, ALB, GGT and ALP) and renal function indexes (BUN, Cr, cys C,β2-MG and RBP) were measured on the preoperative day 1, postoperative day 1 and postoperative day 3.ResultsThere were no significant differences in gender, age, BMI, type of resection between two groups. The operation time[(245.18±42.75)min] in LAG group was significantly longer than that[(184.27±34.72)min] in OG group. The blood loss volume[(78.40±40.69)ml],hospitalization days[(9.26±1.75)d] were significantly lower than those[(98.31±48.05)ml,(11.31±2.08)d] in OG group. LAG group harvested 30.13±9.58 lymph nodes vs.31.42±11.47 in OG group, and there was no significant difference. Two patients in LAG group suffered from duodenal stump fistula after surgery. One patient suffered from duodenal stump fistula, and another suffered from anastomotic leakage of the esophagogastrostomy in OG group. There were no significant differences in IL-6, TNF-α, CRP, HO-1, WBC, hepatic function indexes and renal function indexes between two groups on the preoperative day 1. Serum IL-6[(83.36±28.52)ng/L], CRP[(80.39±10.95)mg/L], HO-1[(14.70±8.59)μg/L] in LAG group were significantly lower than those in OG group[(103.43±41.29)ng/L, (94.06±20.27)mg/L, (20.81±9.28)μg/L] on the postoperative day 1. Serum HO-1[(22.72±9.70)μg/L] in LAG group was significantly lower than that in OG group[(31.59±10.57)μg/L] on the postoperative day 3. There were no significant differences in hepatic function indexes and renal function indexes between two groups on the postoperative day 1 and postoperative day 3.ConclusionsThe short-term outcomes of Laparoscopy-assisted radical gastrectomy were comparable to those of conventional open radical gastrectomy in the treatment of AGC. Laparoscopy-assisted radical gastrectomy for AGC was minimally invasive causing less stress reaction and inflammation. The impacts of laparoscopy-assisted radical gastrectomy on hepatic and renal function were comparable to those of conventional open radical gastrectomy when CO2 pneumoperitoneum pressure was maintained at 12-15mmHg.