胃癌新辅助化疗后完全腔镜全胃切除术安全性与短期疗效观察

Safety and short-term efficacy comparison of laparoscopic total gastrectomy after neoadjuvant chemotherapy for gastric cancer

目的:比较进展期胃癌新辅助化疗(NACT)后行完全腹腔镜全胃切除术(TLTG)与腹腔镜辅助全胃切除术(LATG)的安全性和短期疗效。方法:回顾性分析2015年1月—2023年8月在北京大学深圳医院胃肠外科收治的73例行NACT的胃癌患者的临床资料。按是否进行腹腔内消化道重建分为TLTG组(n=31)和LATG组(n=42)。收集并比较两组患者的基本资料、短期临床疗效(包括手术相关指标、并发症和术后恢复指标)。结果:TLTG组TLTG组术中出血量及术后第1天引流量、WBC少于LATG组,腹部手术切口小于LATG组,术后首次排气时间、首次进流食时间均早于LATG组,术后第3天VAS评分低于LATG组,手术时间及术后住院时间短于LATG组,差异有统计学意义(P<0.05)。NACT后,两组的淋巴结清扫总数、阳性淋巴结数目、经治疗后病理分期、原发肿瘤病理分期、淋巴结病理分期、病理治疗反应分级、肿瘤分化程度、Lauren分型、首次下床活动时间、排便时间、引流管拔管时间、术后第3天WBC、术后3d血红蛋白水平、术后3d白蛋白水平、术后并发症比较,差异均无统计学意义(P>0.05)。结论:相较于LATG,TLTG术后恢复更快、术中出血量更少、手术切口更短、手术时间更短,安全性较好。

Objective To compare the safety and short-term efficacy differences between totally laparoscopic total gastrectomy(TLTG)and laparoscopic-assisted total gastrectomy(LATG)after neoadjuvant chemotherapy for advanced gastric cancer.Methods Clinical data of 73 patients with gastric cancer who underwent neoadjuvant chemotherapy at the Department of Gastrointestinal Surgery,Peking University Shenzhen Hospital from January 2015 to August 2023 were retrospectively analyzed.Patients were divided into TLTG group(n=31)and LATG group(n=42)based on whether intracorporeal digestive tract reconstruction was performed.Baseline characteristics and short-term clinical outcomes(including surgical-related parameters,complications,and postoperative recovery indicators)were collected and compared between the two groups.Results The intraoperative blood loss,drainage volume and white blood cell count(WBC)on the first day after operation in TLTG group were less than those in LATG group.The abdominal incision in TLTG group was smaller than that in LATG group.The first exhaust time and first liquid diet time after operation in TLTG group were earlier than those in LATG group.The VAS score on the third day after operation in TLTG group was lower than that in LATG group.The operation time and postoperative hospital stay in TLTG group were shorter than those in LATG group(P<0.05).There were no significant differences between the two groups in terms of total number of lymph nodes retrieved,number of positive lymph nodes,post-therapy TNM staging,primary tumor pathologic staging,lymph node pathologic staging,tumor regression grade,tumor differentiation,Lauren classification,time to first ambulation,time to first bowel movement,time to removal of drainage tube,WBC on postoperative day 3,hemoglobin level on postoperative day 3,albumin level on postoperative day 3,and postoperative complications(P>0.05).Conclusions Compared to LATG,TLTG is associated with faster postoperative recovery,less intraoperative blood loss,shorter abdominal incision,and shorter operation time,but it does not demonstrate a significant advantage in terms of complication rates.