Feasibility and nutritional impact of laparoscopic assisted tailored subtotal gastrectomy for middle-third gastric cancer

查看全文 作　　者：Hao [1,2]Liu;Peng [1]Jin;Fu-Hai [1]Ma;Shuai [1]Ma;Yi-Bin [1]Xie;Yang [1]Li;Wei-Kun [3]Li;Wen-Zhe [1]Kang;Yan-Tao [1]Tian

机构地区：[1]Department of Pancreatic and Gastric Surgery,National Cancer Center/National Clinical Research Center for Cancer/Cancer Hospital,Chinese Academy of Medical Sciences and Peking Union Medical College,Beijing 100021,China;[2]Department of Gastrointestinal Surgery,The Second Hospital,Jilin University,Changchun 130041,Jilin Province,China;[3]Department of Pancreatic Stomach Surgery,National Cancer Center/Cancer Hospital,Chinese Academy of Medical Sciences and Peking Union Medical College,Beijing 100021,China

出　　处：《World Journal of Gastroenterology》索引2020年第26卷第43期,共16页

基　　金：Supported by National Natural Science Foundation of China,No.81772642;Beijing Municipal Science and Technology Commission,No.Z161100000116045;Capital’s Funds for Health Improvement and Research,No.CFH 2018-2-4022。 摘　　要：BACKGROUND Laparoscopic assisted total gastrectomy(LaTG)is associated with reduced nutritional status,and the procedure is not easily carried out without extensive expertise.A small remnant stomach after near-total gastrectomy confers no significant nutritional benefits over total gastrectomy.In this study,we developed a modified laparoscopic subtotal gastrectomy procedure,termed laparoscopicassisted tailored subtotal gastrectomy(LaTSG).AIM To evaluate the feasibility and nutritional impact of LaTSG compared to those of LaTG in patients with advanced middle-third gastric cancer(GC).METHODS We retrospectively analyzed surgical and oncological outcomes and postoperative nutritional status in 92 consecutive patients with middle-third GC who underwent radical laparoscopic gastrectomy at Department of Pancreatic Stomach Surgery,National Cancer Center/Cancer Hospital,Chinese Academy of Medical Sciences,and Peking Union Medical College between 2013 and 2017.Of these 92 patients,47 underwent LaTSG(LaTSG group),and the remaining underwent LaTG(LaTG group).RESULTS Operation time(210±49.8 min vs 208±50.0 min,P>0.05)and intraoperative blood loss(152.3±166.1 mL vs 188.9±167.8 mL,P>0.05)were similar between the groups.The incidence of postoperative morbidities was lower in the LaTSG group than in the LaTG group(4.2%vs 17.8%,P<0.05).Postoperatively,nutritional indices did not significantly differ,until postoperative 12 mo.Albumin,prealbumin,total protein,hemoglobin levels,and red blood cell counts were significantly higher in the LaTSG group than in the LaTG group(P<0.05).No significant differences in Fe or C-reaction protein levels were found between the two groups.Endoscopic examination demonstrated that reflux oesophagitis was more common in the LaTG group(0%vs 11.1%,P<0.05).Kaplan–Meier analysis showed a significant improvement in the overall survival(OS)and disease free survival(DFS)in the LaTSG group.Multivariate analysis showed that LaTSG was an independent prognostic factor for OS(P=0.048)but not for DFS(P=0.054).Subgroup analysis showed that compared to LaTG,LaTSG improved the survival of patients with stage III cancers,but not for other stages.CONCLUSION For advanced GC involving the middle third stomach,LaTSG can be a good option with reduced morbidity and favorable nutritional status and oncological outcomes. 关键词：Gastric cancer Laparoscopy assisted tailored gastrectomy Nutritional status MORBIDITY Reflux oesophagitis Resection margin

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Feasibility and nutritional impact of laparoscopic assisted tailored subtotal gastrectomy for middle-third gastric cancer

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