Efficacy Analysis Of Laparoscopy-assisted Radical Gastrectomy And Endoscopic Submucosal Dissection In The Treatment Of Stage ⅠA Gastric Cancer

Objective:The clinical data of laparoscopic-assisted radical gastrectomy and endoscopic submucosal dissection in the treatment of stage ⅠA gastric cancer were retrospectively analyzed,and the short-term efficacy of the two surgical methods was compared to provide a basis for clinicians to make decisions.Method:A retrospective research method was used to collect the clinical data of patients with early gastric cancer who were treated in the China-Japan Union hospital of Jilin University from January 2018 to November 2021.According to the inclusion and exclusion criteria of this study,a total of 122 patients met the conditions.Then they were divided into endoscopic submucosal dissection（ESD）group and laparoscopic-assisted radical gastrectomy（LARG）group according to different surgical methods.The general data,tumor pathological characteristics,intraoperative and postoperative clinical data of the two groups were compared,postoperative follow-up data and other data,using SPSS statistical software for data analysis,when P<0.05 was considered statistically significant.Results:There was no significant difference in general data and postoperative pathological data between the two groups of patients,and this study could be carried out on this basis.（1）Intraoperative and postoperative clinical data: Compared with the LARG group,the ESD group had a shorter operation time（100.52±39.52 min vs241.41±63.96 min,P<0.001）,and an earlier postoperative exhaust time [2.000（2.000,2.500）d vs 4.000（3.000,4.625）d,P<0.001],earlier postoperative gastric tube removal [2.000（2.000,3.000）d vs 7.000（5.000,9.000）d,P<0.001],earlier postoperative eating [2.000（2.500,3.000）d vs 7.000（5.000,9.000）d,P<0.001],the time to go to the ground after operation was earlier [1.500（1.000,2.000）d vs 3.000（2.875,4.000）d,P<0.001],the postoperative hospital stay was shorter [7.00（6.25,7.75）d vs 12.00（10.00,15.00）d,P<0.001],and the rate of curative tumor resection was lower [40（83.3%）vs 74（100%）,P<0.001],low hospitalization expenses（22604.63±2383.41 yuan vs 91718.44±9223.37 yuan,P<0.001）,the differences of the above variables were statistically significant.（2）Postoperative complications: the incidence of complications in the ESD group was lower than that in the LARG group,short-term complications [4（8.3%）vs 21（28.4%）,P=0.007],long-term complications[2（4.4%）vs 20（30.3%）,P=0.001],the difference in postoperative complications between the two groups was statistically significant.（3）Postoperative follow-up data:There was no significant difference in the loss to follow-up rate between the two groups,[3（6.3%）vs 8（10.8%）,P=0.524];there was no significant difference in mortality between the two groups,[0 vs 2（3.0%）,P=0.514];there was no significant difference in local recurrence rate between the two groups [2（4.4%）vs 0,P=0.162];there was no significant difference in liver and lung metastases between the two groups [0 vs 1（1.5%）,P=1.000],and no statistically significant difference in 3-year cumulative survival rate between the two groups [100% vs 95.8%,P=0.257].Conclusions:1.For stage ⅠA gastric cancer,especially intramucosal cancer（T1a）,endoscopic submucosal dissection is a safe and effective treatment method,and the postoperative short-term effect is better than laparoscopic-assisted radical gastrectomy.2.Endoscopists should strictly follow the indications for endoscopic submucosal dissection,and evaluate the e Cura evaluation system after surgery.3.For stage ⅠA gastric cancer,the curative resection rate of postoperative tumor in the LARG group was higher than that in the ESD group.