Hand-Assisted Laparoscopic Versus Laparoscopy-Assisted Radical Gastrectomy:A Randomized Controlled Clinical Study

Objective Gastric cancer is a malignant tumor with a high incidence and is the third leading cause of death from cancer.operative excision is still the major treatment,including the traditional abdominal procedure and laparoscopy procedure.With the rapid development of laparoscopic techniques at home and abroad.Minimally invasive surgery that represented by laparoscopic is gaining in popularity.Hand-assisted laparoscopic surgery is an important branch of laparoscopy procedure,which combining both virtues,can achieving the same effect as abdominal procedure,at the same time,as the Minimally invasive surgery.However,the advantages and disadvantages of the hand-assisted laparoscopy and the laparoscopy remain controversial during radical resection of gastric cancer.For instance,the former operation will cover visual operative field when the operator reaches into the gut cavity,and pyloric lymph node dissection needs to be completed under laparotomy.In addition,laparoscopic surgery requires long-term learning and close teamwork.Therefore,this research aims to compare the safety and clinical efficacy of hand-assisted laparoscopic versus laparoscopy assisted radical gastrectomy for gastric cancer,to investigate the advantage and development trend of Hand-assisted laparoscopic surgery during radical resection of gastric cancer.Methods Perspective study of 101 patients with gastric carcinoma between June 2013 and December 2014 diagnosed in our gastrointestinal department.All patients were diagnosed as cancer by electronic gastroscopy and pathological biopsy before operation.They were randomly divided into the hand-assisted laparoscopic group(n=51)or the laparoscopic group(n=50)according to random number table.The operation time,the amount of bleeding and lymph node dissection,abdominal incision length were compared between the two groups and the first ventilation time,the incidences of postoperative complications,hospital stay time were also closely observed.The clinical data and observation indexes of both groups were recorded in the database.All patients were followed up for 3 years,followed up every 3 months in the first year,and every 6 months in the 2nd and 3rd years,and follow-up methods include outpatient visits and telephone follow-up.The primary end-point of this study would be death in patients or the end of the follow-up period.Data processing and statistical analysis using SPSS 22.0 statistical analysis package,Measurement data using T tests testing method,expressed as mean±standard and calculators information is chi-square test.Results: The operation time(179 ±33 min)of the hand-assisted laparoscopic group was lower than that of the laparoscopic group(206 ±36 min),and the difference was statistically significant between the two groups(P<0.05).Number of the lymph node dissection were 27.18±7.12,27.98±9.93 respectively,in the hand-assisted laparoscopic group and the laparoscopic group.And the amount of bleeding were(180±109)ml and(158±64)ml,abdominal incision length(5.8±0.63)cm and(5.56±0.64)cm,respectively,with no significant differences between two groups.Gastrointestinal function recovery time were(3.57±0.7)day,(3.56±0.65)day,and the length of hospital stay(8.27±2.01)day,(8.62±2.41)day,respectively,with no significant differences between two groups(P>0.05).In addition,there were 5 cases of postoperative complications,including anastomotic leakage 2 cases,gastrointestinal dysfunction 1 case,abdominal infection1 case,and of pulmonary infection1 case in the hand-assisted laparoscopic group.In the laparoscopic radical gastrectomy,postoperative complications 4 cases include anastomotic leakage 1case,postoperative gastroplegia 1 case,gastrointestinal dysfunction 1 case and abdominal infection1 case.The morbidity of postoperative complication of two groups had no statistical difference.The patients were followed-up for 3 months,overall survival was 56.8%and 64% respectively,in the hand-assisted laparoscopic group and the laparoscopic group with no significant differences.Conclusion Hand-assisted laparoscopic radical gastrectomy and laparoscopic radical gastrectomy can achieve the same radical effects,but the hand-assisted laparoscopic surgery is shorter and the learning period is shorter,which is worthy of promotion in primary hospitals.