Short-term Clinical Outcomes Of Laparoscopy-assisted Gastrectomy Versus Open Gastrectomy For Early Gastric Cancer:A Propensity-matched Analysis

ObjectiveTo explore the feasibility and safety of laparoscopy-assisted distal gastric cancer(LADG)in patients with early gastric cancer,and postoperative short-term results,such as the difference in perioperative blood test results,and in the related indicators to find the impact of postoperative complications of risk factors.MethodsIn the second affiliated hospital of Zhejiang University,the digital historical medical record retrieval system and EMRS system were selected to identify the early gastric cancer cases from January 2007 to January 2017.The cases of early gastric cancer with Billroth-Ⅱ anastomosis were collected in selected cases,then according to the demographic characteristics of the patient(gender,age),tumor lesion depth(T stage),American Association of Narcotic Physicians Classification Standard(asa-class),body mass index(BMI)and nutritional risk score(NRS2002),combining the different operation methods to select 100 cases with propensity score matching.then,compare the difference of the short-term indexes between the two groups of different operation methods.ResultsThere was no statistically significant difference between the two groups in gender,age,nutrition risk score,American Physicians Association grading Standard,tumor invasion depth and body mass index(P>0.05)。There were significant statistical differences in operative time between laparoscopic and open Group(LADG vs ODG:249min vs 195min,p<0.01).However,there was significant difference in the difference of leukocyte count between laparoscopic and open Group in perioperative period(LADG vs ODG:1.02 vs 1.62,p<0.01).The intestinal function of the laparoscopic group can be recovered sooner after operation(Postoperative anus Exhaust Day:LADG vs ODG:3.13days vs 4.07days,p<0.01).The number of days in which the laparoscopic group used total parenteral nutrition was significantly less than that of open group(LADG vs ODG:4.82days vs 7.50days,p<0.05).The total number of lymph node acquired in the laparoscopic group are more(LADG vs ODG:27 vs 22,p<0.05).There was no significant difference in the incidence of postoperative complications in two groups of patients(LADG vs ODG:22%vs 14%,p>0.05).In multivariate logistic regression analysis,there was a statistically significant difference between age(patients aged less than 60 years of age(OR=0.119,95%CI=0.031-0.449,P=0.002<0.01)and BMI(20.35kg/m2<BMI≤24.65 kg/m2 compared with BMI>24.65 kg/m 2)(O R =0.105,95%CI=0.024-0.467,p=0.003<0.01).Conclusions1.In the early stage of gastric cancer,LADG may require longer operation time than ODG,however,in the short-term outcome,the laparoscopic group has a quicker recovery period,comparing with postoperative exhaust day and postoperative parenteral nutrition Day.Moreover,LADG has a lower inflammatory index fluctuation after operation.2.LADG did not significantly increase the incidence of postoperative complications.3.In this paper,the independent risk factors affecting postoperative complications were over the 60-year-old(including 60-year-old)and BMI which is over 24.65 kg/m2 compared with BMI between 20.35kg/m2 and 24.65 kg/m2.