新辅助化疗联合完全腹腔镜下远端胃癌D2根治术的临床疗效

Efficacy of neoadjuvant chemotherapy combined with complete laparoscopic D2 radical resection for distal gastric cancer

目的探讨新辅助化疗联合完全腹腔镜下远端胃癌D2根治术的临床疗效及对复发率和死亡率的影响。方法观察2015年1月至2017年6月预行根治性远端胃切除的72例患者,其中观察组为SOX方案新辅助化疗后行完全腹腔镜根治性远端胃切除的33例患者,对照组为仅行完全腹腔镜根治性远端胃切除的39例患者。分析两组手术时间、术中出血量、中转开腹率、淋巴结清扫数目、术后手术相关并发症、非手术并发症、术后分期、复发及远处转移等临床资料。结果观察组新辅助化疗有效率54.55%(18/33);观察组患者术后TNM分期与对照组相比较术前下降,差异有统计学意义(P<0.05)。观察组手术时间[(248.0±37.0)minvs(224.9±29.6)min]、术中出血量[(139.4±51.7)mlvs(109.6±48.7)ml]较对照组略有增加,差异具有统计学意义(P<0.05);两组在淋巴结清扫数目和术后并发症等方面对比差异无统计学意义(P>0.05)。随访时间截至2017年10月,与对照组相比,观察组肿瘤复发转移(12.1%vs41.0%)及死亡率(6.0%vs76.9%)降低,差异有统计学意义(P<0.05)。结论新辅助化疗联合完全腹腔镜下远端胃癌D2根治术是安全、可行的,手术创伤更小,恢复快,且短期疗效具有优势。

Objective To explore the clinical efficacy of neoadjuvant chemotherapy ( NACT) combined with totally laparoscopic distal gastrectomy with D2 lymphadenectomy. Methods A total of 72 patients undergoing radical distal gastrectomy from January 2015 to June 2017 were enrolled and divided into observation group ( n = 33 ) in which totally laparoscopic distal gastrectomy was performed after neoadjuvant chemotherapy with SOX regimen ( oxaliplatin combined with tegio capsules) and control group(n =39) in which totally laparoscopic distal gastrectomy was conducted alone. The operation time, intraoperative bleeding volume, rate of conversion to laparotomy, number of lymph node dissection, postoperative complications, non-operative complications, post-operative staging, recurrence and distant metastasis were retrospectively analyzed in two groups. Results The effective rate was 54. 55%(18/33 ) in observation group, and the post-operative TNM stage was significantly lower than that in control group ( P < 0. 05 ). The operation time [( 248. 0 ± 37. 0) min vs (224. 9 ±29. 6) min], intraoperative bleeding [(139. 4 ±51.7) ml vs (109. 6 ± 48. 7) ml] in observation group were statistically higher than those in control group ( all P < 0. 05 ). There were no significant differences in lymph node dissection number and postoperative complications between two groups (all P > 0. 05). The follow-up period ended in October 2017, and the tumor recurrence and metastasis ( 12. 1% vs 41. 0%) and mortality (6. 0% vs 76. 9%) significantly decreased in observation group compared with control group (P < 0. 05). Conclusion It is concluded that SOX regimen combined totally laparoscopic distal gastrectomy with D2 lymphadenectomy is safe and feasible with less trauma and rapid recovery and has advantage in short-term efficacy.