| Objective:The feasibility and safety of en bloc mesogastric excision based on symmetry were explored by comparing the differences between en bloc mesogastric excision(EME)based on symmetry and D2 radical surgery.Methods:From January 2014 to January 2016,the study collected data from 120 patients who underwent en bloc mesogastric excision and D2 radical resection of gastric cancer in our department.According to the different surgical guidance concepts,60 patients(EME group)underwent en bloc mesogastric excision under the guidance of symmetry,and 60 patients(D2 group)under D2 radical surgery.The clinical data of the patients included: intraoperative blood loss,number of lymph nodes removed,operation time,3-year local recurrence rate,surgical complications,postoperative hospital stay,3-year recurrence and metastasis rate,and 3-year overall survival and mortality.Results:Sixty patients in the en bloc mesogastric excision group(EME group)and 60 patients in the D2 radical surgery group(D2 group)were included in the study.Baseline data: gender ratio,age,weight mass,tumor type,tumor size,tumor location,and tumor TNM staging were not statistically significant(P>0.05).Therefore,the clinical data of the two groups of patients are comparable.The intraoperative blood loss(36.9 ± 11.2 ml)in the EME group was compared with the intraoperative blood loss(46.9 ± 16.4 ml)in the D2 group.The difference between the two groups was statistically significant(P<0.05).There was a statistically significant difference between the two groups in the EME group(134.3±16.4 min)and the D2 group(145.6 ± 19.1 min)(P<0.05).The number of lymph node dissections in the EME group(30.1±5.5)was significantly different from the number of lymph node dissections in the D2 group(26.1±7.7)(P<0.05).The postoperative hospital stay(9.2±1.8d)in the EME group and the postoperative hospital stay in the D2 group(9.5±2.0d)were not significantly different(P>0.05).Surgical complications: EME group: 1 case of wound infection,3 cases of pulmonary infection,1 case of postoperative abdominal hemorrhage,1 case of duodenal stump;D2 group: 2 cases of wound infection and 3 cases of pulmonary infection.There were no significant differences in the number of complications and overall complications(P>0.05).Twenty-one patients with recurrence in the EME group were followed up for 3 years,accounting for 35% of the patients in the EME group;21 patients died,of which 17 patients died of tumor recurrence,and the remaining 4 patients died of other causes.28 patients in the D2 group relapsed,accounting for 46.7% of the total number of patients in the D2 group,25 patients died,24 patients died of tumor recurrence,and the remaining 1 patient died of other causes.The 3-year overall survival and mortality were not statistically significant between the two groups(P>0.05).There were statistically significant differences between the 6 patients with local recurrence in 3 years(10%)and 12 patients with local recurrence in 3 years(20%)in the D2 group(P<0.05).Conclusion:1.EME meets the principles of radical gastrectomy and meets the safety principles of surgery.2.Compared with traditional gastric cancer D2 radical surgery,EME,which is guided by operative complications,postoperative hospital stay,3-year recurrence and metastasis rate,and 3-year mortality symmetry,is not inferior to gastric cancer D2 radical surgery.Symmetrically guided EME was superior to gastric cancer D2 radical surgery in terms of operative time,intraoperative blood loss,number of lymph node dissections during surgery,and 3-year local recurrence rate in postoperative follow-up data.3.En bloc mesogastric excision is a new idea of radical gastrectomy,and the symmetry is proposed to make the anatomy of the whole stomach more regional and standardized,so that the surgeon can easily accept the concept of en bloc mesogastric excision.And it is easier to perform en bloc mesogastric excision during surgery. |
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