腹腔镜辅助与开腹近端胃切除对SiewertⅡ型和Ⅲ型食管胃结合部腺癌疗效比较
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摘要
目的:研究腹腔镜辅助近端胃切除术(laparoscopic-assisted proximal gastrectomy,LAPG)和开腹全胃切除术(open proximalgastrectomy,OPG)治疗SiewertⅡ型和Ⅲ型食管胃结合部腺癌(adenocarcinoma of the esophagogastric junction,AEG)的临床疗效。方法:回顾性分析蚌埠医学院第一附属医院2015年2月至2017年2月收治的116例行近端胃切除的SiewertⅡ型和Ⅲ型AEG患者的临床资料,其中LAPG组48例、OPG组68例。分析两组患者的临床病理特征、术中情况、根治效果与肿瘤复发情况。结果:两组患者手术均顺利完成,无围手术期死亡。LAPG组患者平均手术时间为(3.46±0.46)h,长于OPG组的(2.68±0.68)h;平均术中出血量为(108±46.8)mL,少于OPG组的(236±86.6)mL;胃肠功能恢复时间为(2.56±0.56)d,短于OPG组的(3.82±0.86)d;术后平均住院时间为(12.24±1.86)d,少于OPG组的(14.68±2.89)d;近端切缘(3.06±0.56)cm长于OPG组的(2.38±0.68)cm(均P<0.05)。两组患者的清扫淋巴结数目、远端切缘、术后并发症发生率,差异均无统计学意义(P>0.05)。结论:LAPG在治疗SiewertⅡ型和Ⅲ型AEG患者的根治效果、术后并发症及肿瘤复发方面与开放手术相当;LAPG具有术中出血少、胃肠功能恢复快、住院时间短的优势,近端切缘更长。
To compare the clinical efficacies of laparoscopic-assisted proximal gastrectomy(LAPG) and open proximal gastrectomy(OPG) for treating Siewert type II and III adenocarcinoma of the esophagogastric junction(AEG). Methods: The clinical data of 116 patients with Siewert type II and III AEG from February 2015 to February 2017 were analyzed retrospectively. Patients were grouped into the LAPG group(48 cases) and the OPG group(68 cases). The efficacy of radical resection, clinicopathological features, perioperative situation, and postoperative tumor recurrence in the two groups were compared. Patients were followed up by telephone or out-patient examination until March 2018. Results: The two groups of patients successfully underwent surgery with no perioperative death.The average operation time was(3.46±0.46) h in the LAPG group, which was longer than that in the OPG group(2.68±0.68) h. The average intraoperative bleeding volume was(108±46.8) mL, which was lower than that in the OPG group(236±86.6) mL. The gastrointestinal function recovery time was(2.56±0.56) d in the LAPG group, which was shorter than that in the OPG group(3.82±0.86) d. The average hospital stay was(12.24 ± 1.86) d in the LAPG group, which was lower than that in the OPG group [(14.68 ± 2.89) d; P<0.05]. The proximal incision margin was longer in OPG group [(3.06±0.56) cm vs.(2.38±0.86) cm, P<0.05]. There were no significant differences in the length of distal resection margins, number of lymph nodes resected, and incidence of postoperative complications between the LAPG and OPG groups(P>0.05). Conclusions: LAPG is comparable to OPG in the treatment of Siewert type Ⅱ and ⅢAEG regarding the aspects of radical resection and tumor recurrence, but LAPG confers less bleeding, less postoperative pain, faster recovery of gastrointestinal function, and shorter hospital stay.
To compare the clinical efficacies of laparoscopic-assisted proximal gastrectomy(LAPG) and open proximal gastrectomy(OPG) for treating Siewert type II and III adenocarcinoma of the esophagogastric junction(AEG). Methods: The clinical data of 116 patients with Siewert type II and III AEG from February 2015 to February 2017 were analyzed retrospectively. Patients were grouped into the LAPG group(48 cases) and the OPG group(68 cases). The efficacy of radical resection, clinicopathological features, perioperative situation, and postoperative tumor recurrence in the two groups were compared. Patients were followed up by telephone or out-patient examination until March 2018. Results: The two groups of patients successfully underwent surgery with no perioperative death.The average operation time was(3.46±0.46) h in the LAPG group, which was longer than that in the OPG group(2.68±0.68) h. The average intraoperative bleeding volume was(108±46.8) mL, which was lower than that in the OPG group(236±86.6) mL. The gastrointestinal function recovery time was(2.56±0.56) d in the LAPG group, which was shorter than that in the OPG group(3.82±0.86) d. The average hospital stay was(12.24 ± 1.86) d in the LAPG group, which was lower than that in the OPG group [(14.68 ± 2.89) d; P<0.05]. The proximal incision margin was longer in OPG group [(3.06±0.56) cm vs.(2.38±0.86) cm, P<0.05]. There were no significant differences in the length of distal resection margins, number of lymph nodes resected, and incidence of postoperative complications between the LAPG and OPG groups(P>0.05). Conclusions: LAPG is comparable to OPG in the treatment of Siewert type Ⅱ and ⅢAEG regarding the aspects of radical resection and tumor recurrence, but LAPG confers less bleeding, less postoperative pain, faster recovery of gastrointestinal function, and shorter hospital stay.
引文
[1]冯鹏才,杨金,唐明杰,等.食管胃结合部腺癌患者行微创手术中淋巴结的清扫效果[J].中国内镜杂志,2017,23(3):42-46.
[2]Huang CM,Lv CB,Lin JX,et al.Laparoscopic-assisted versus open total gastrectomy for Siewert typeⅡandⅢesophagogastric junction carcinoma:a propensity score-matched case-control study[J].Surg Endosc,2017,31(9):3495-3503.
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[7]Yamashita H,Seto Y,Sano T,et al.Results of a nation-wide retrospective study of lymphadenectomy for esophagogastric junction carcinoma[J].Gastric Cancer,2017,20(Suppl 1):69-83
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[9]Li C,Li R,Zhang W.Progress in non-invasive detection of liver fibrosis[J].Cancer Biol Med,2018,15(2):124-136.
[10]Kitano S,Iso Y,Moriyama M,et al.Laparoscopy-assisted Billroth I gastrectomy[J].Surg Laparosc Endosc,1994,4(2):146-148.
[11]Kim HH,Hyung WJ,Cho GS,et al.Morbidity and mortality of laparoscopic gastrectomy versus open gastrectomy for gastric cancer:an interim report--a phaseⅢmulticenter,prospective,randomized Trial(KLASS Trial)[J].Ann Surg,2010,251(3):417-420.
[12]季加孚,季鑫.食管胃结合部腺癌的外科治疗[J].中华消化外科杂志,2014,13(2):81-84.
[13]陈秀峰,陈海宁,张波,等.Ⅱ、Ⅲ型食管胃结合部腺癌的临床分析[J].四川大学学报(医学版),2012,43(2):289-292.
[14]Vrba R,AujeskyR,Neoral?,et al.Proximal gastrectomy for adenocarcinoma of the gastroesophageal junction in a selected set of patients immediate and long-term results[J].Rozhl Chir,2016,95(12):439-443
[15]卢太亮,廖国庆.腹腔镜与开腹手术治疗进展期胃癌疗效的Meta分析[J].中华消化外科杂志,2014,13(5):325-331.
[16]Wang JB,Lin MQ,Li P,et al.The prognostic relevance of parapyloric lymph node metastasis in Siewert typeⅡ/Ⅲadenocarcinoma of the esophagogastric junction[J].Eur J Surg Oncol,2017,43(12):2333-2340.
[17]Zheng Z,Yin J,Wu HW,et al.Explored risk factors for lymph node metastasis with siewertⅡ/Ⅲadenocarcinoma of the gastroesophageal junctio[J].Anticancer Res,2017,37(8):4605-4610
[18]Hosoda K,Yamashita K,Moriya H,et al.Optimal treatment for Siewert typeⅡandⅢadenocarcinoma of the esophagogastric junction:A retrospective cohort study with long-term follow-up[J].World J Gastroenterol,2017,21;23(15):2723-2730.
[19]Hatta W,Tong D,Lee YY,et al.Different time trend and management of esophagogastric junction adenocarcinoma in three Asian countries[J].Dig Endosc,2017,29(2):18-25.
[2]Huang CM,Lv CB,Lin JX,et al.Laparoscopic-assisted versus open total gastrectomy for Siewert typeⅡandⅢesophagogastric junction carcinoma:a propensity score-matched case-control study[J].Surg Endosc,2017,31(9):3495-3503.
[3]Japanese Gastric Cancer Association.Japanese gastric cancer treatment guidelines 2014(ver.4)[J].Gastric Cancer,2017,20(1):1-19.
[4]Japanese Esophageal Society.Japanese classification of esophageal cancer,11th edition[J].Esophagus,2017,14(1):1-36.
[5]Sano T,Coit DG,Kim HH,et al.Proposal of a new stage grouping of gastric cancer for TNM classification:International Gastric Cancer Association staging project[J].Gastric Cancer.2017,20(2):217-225.
[6]孙益红,汪学非.食管胃结合部腺癌的微创外科治疗[J].中华消化外科杂志,2014,13(2):89-91.
[7]Yamashita H,Seto Y,Sano T,et al.Results of a nation-wide retrospective study of lymphadenectomy for esophagogastric junction carcinoma[J].Gastric Cancer,2017,20(Suppl 1):69-83
[8]孙益红,沈振斌.食管胃结合部腺癌根治术的争议与评价[J].中国实用外科杂志,2011,31(8):662-664.
[9]Li C,Li R,Zhang W.Progress in non-invasive detection of liver fibrosis[J].Cancer Biol Med,2018,15(2):124-136.
[10]Kitano S,Iso Y,Moriyama M,et al.Laparoscopy-assisted Billroth I gastrectomy[J].Surg Laparosc Endosc,1994,4(2):146-148.
[11]Kim HH,Hyung WJ,Cho GS,et al.Morbidity and mortality of laparoscopic gastrectomy versus open gastrectomy for gastric cancer:an interim report--a phaseⅢmulticenter,prospective,randomized Trial(KLASS Trial)[J].Ann Surg,2010,251(3):417-420.
[12]季加孚,季鑫.食管胃结合部腺癌的外科治疗[J].中华消化外科杂志,2014,13(2):81-84.
[13]陈秀峰,陈海宁,张波,等.Ⅱ、Ⅲ型食管胃结合部腺癌的临床分析[J].四川大学学报(医学版),2012,43(2):289-292.
[14]Vrba R,AujeskyR,Neoral?,et al.Proximal gastrectomy for adenocarcinoma of the gastroesophageal junction in a selected set of patients immediate and long-term results[J].Rozhl Chir,2016,95(12):439-443
[15]卢太亮,廖国庆.腹腔镜与开腹手术治疗进展期胃癌疗效的Meta分析[J].中华消化外科杂志,2014,13(5):325-331.
[16]Wang JB,Lin MQ,Li P,et al.The prognostic relevance of parapyloric lymph node metastasis in Siewert typeⅡ/Ⅲadenocarcinoma of the esophagogastric junction[J].Eur J Surg Oncol,2017,43(12):2333-2340.
[17]Zheng Z,Yin J,Wu HW,et al.Explored risk factors for lymph node metastasis with siewertⅡ/Ⅲadenocarcinoma of the gastroesophageal junctio[J].Anticancer Res,2017,37(8):4605-4610
[18]Hosoda K,Yamashita K,Moriya H,et al.Optimal treatment for Siewert typeⅡandⅢadenocarcinoma of the esophagogastric junction:A retrospective cohort study with long-term follow-up[J].World J Gastroenterol,2017,21;23(15):2723-2730.
[19]Hatta W,Tong D,Lee YY,et al.Different time trend and management of esophagogastric junction adenocarcinoma in three Asian countries[J].Dig Endosc,2017,29(2):18-25.