Clinical Study On The Effect Of Laparoscopic Assisted Radical Gastrectomy On Peritoneal Micrometastasis

Objectives: To study the relationship between peritoneal micrometastasis and clinicopathological factors,to explore the effect of laparoscopic-assisted radical gastrectomy on peritoneal micrometastasis of gastric cancer,and to analyze the relationship between peritoneal micrometastasis and prognosis.Methods: Patients undergoing laparoscopic assisted radical gastrectomy for gastric cancer in the Department of Gastrointestinal and Gland Surgery,First Affiliated Hospital of Guangxi Medical University from December 2017 to September 2018 were selected.Peritoneal lavage fluid was collected before and after operation,and 41 patients with negative cytological examination of peritoneal lavage fluid before operation were included in the study.RT-PCR was used to detect the expression of CEA mRNA and DDC mRNA in peritoneal lavage fluid.The positive expression of either of the two was regarded as positive for peritoneal micrometastasis.Study the correlation between preoperative CEA mRNA and DDC mRNA expression and clinicopathological factors,and to compare the changes of CEA mRNA and DDC mRNA expression before and after surgery.Patients were followed up postoperatively to analyze the relationship between peritoneal micrometastasis and postoperativedisease-free survival(DFS).Results: 1.The positive rate of CEA mRNA and DDC mRNA in preoperative peritoneal lavage fluid increased with the increase of TNM stage,depth of infiltration,lymph node metastasis and serosal invasion(P<0.05).No significant relationship between tumor location,tumor size,vascular invasion,perineural invasion and CEA mRNA and DDC mRNA of pre-operation(P>0.05).2.Preoperative positive rates of CEA mRNA,DDC mRNA and combined detection were 41.5%(17/41),31.7%(13/41)and 46.3%(19/41),respectively.Postoperative positive rates of CEA mRNA,DDC mRNA and combined detection were 48.8%(20/41),41.5%(17/41)and 58.5%(24/41),respectively.The positive rate of postoperative CEA mRNA and DDC mRNA is not significantly higher than that before operation(P>0.05).3.All patients included in the study were followed up for 4-16 months,1 patient(2.4%)lost follow-up,3 patients(7.3%)with metastasis and recurrence,and 5 patients(12.2%)died.The DFS of patients with positive postoperative combined detection within 16 months was lower than that of negative(P<0.05).Conclusion: 1.Late tumor stage,deep infiltration,lymph node metastasis and serosal invasion are risk factors for peritoneal micrometastasis of gastric cancer;2.Laparoscopic-assisted radical gastrectomy don't increase the risk of peritoneal micrometastasis;3.The prognosis of gastric cancer patients with positive peritoneal micrometastasis is worse than that of those without.