| ObjectCompare the efficacy of Laparoscopic Assisted Radical Gastrectomy(LARG)and Endoscopic Submucosal Dissection(ESD)for Early Gastric Cancer(EGC)with different lymph node metastasis risk.And further explore the suitable treatment of early gastric cancer surgery.Materials and methodsThe clinicopathological data of 233 patients with ESD or LARG in our hospital from January 1,2011 to December 31,2016 were retrospectively reviewed.10 cases of them were excluded because of previous malignant tumors of other system,3 cases of them were excluded because of the previous gastric cancer,20 cases of them were excluded because of severe basic diseases,and finally 190 cases were included in the study.There were 33 cases in group ESD and 157 in group LARG.The baseline data,oncology characteristics,long and short term clinical efficacy and 3 year cumulative survival rate of two groups were retrospectively compared.Single-factor and two variable Logistic regression multiple factor were used to analyze the influencing factors of lymph node metastasis in laparoscopic surgery group.The tumor free survival rates of EGC with different lymph node metastasis risk were compared between ESD and LARG after operation.Follow up by out-patient or telephone.Results(1)The short-term clinical results: 1.In the perspective of operation trauma,the operation time of ESD group was smaller,the operation time was shorter [(67.48±18.49)min vs(170.47±53.45)min,P<0.001],and the tube drainage was not needed after the operation.The rate of the LARG group was 94.9% with(6.4±3.47)days;2.In the perspective of postoperative recovery,the first time of getting out of bed was shorter [(1.5±0.79)d vs(3.4±1.46)d,P<0.001],postoperative first exhaust time was shorter [(2.6±0.94)d vs(4.1±1.83)d,P<0.001],postoperative fluid intake time was shorter [(3.2±1.13)d vs(5.5±2.65)d,P<0.001] but the incidence of short-term complications was higher [9.09%(3/33)vs 6.37%(10/157),P=0.024];3.In the perspective of health economics,the cost of surgery and total hospitalization in the ESD group were lower than those in the laparoscopic surgery group [(17355.86±14553.01)yuan vs(27117.52± 8939.56)yuan,P<0.001],[(46732.86±28200.55)yuan vs(59630.6±15544.75)yuan,P=0.010],but the cost of auxiliary examination was significantly higher than that of the laparoscopic surgery group [(8705.48±3979.98)yuan vs(6842.66±2973.83)yuan,P=0.002].(2)The long term clinical results,there was no statistical significance of the difference in the incidence of long-term complications between the two groups [12.5%(4/33)vs 15.4%(20/157),P=0.788].There was no statistical significance of the difference in the cumulative survival rate in the 3 years [96.7% vs 98.5%,P=0.442].For early gastric cancer with low lymph node metastasis risk,there was no statistical difference between the two groups after operation [93.8% vs 100%,P=0.097].But for the early gastric cancer with the risk of lymph node metastasis,the ESD group had a lower tumor free survival rate [84.4% vs 99.1%,P=0.004].(3)The single factor analysis of the factors affecting lymph node metastasis in the laparoscopic operation group showed that the tumor size(P<0.001),depth of invasion(P<0.001),histological type(P=0.012),and lymphatic tumor thrombus(P=0.003)were associated with lymph node metastasis,and multiple factor analysis of two element Logistic regression revealed that the tumor size(P<0.001),the depth of tumor invasion(P=0.004),vascular invasion(P=0.037)were independent risk factor for the metastasis of lymph nodes.ConclusionsFor EGC with low lymph node metastasis risk,ESD has less trauma,rapid recovery,higher complications and no significant difference between postoperative recurrence rate and surgical treatment;EGC with lymph node metastasis risk,laparoscopic assisted radical gastrectomy can reduce the postoperative recurrence rate.For EGC,tumor diameter,invasion depth and vascular tumor thrombus are independent risk factors for lymph node metastasis. |
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