To compare the effect of different surgical procedures on advanced gastric carcinoma (AGC) in middle and upper part, to investigate the advantages of laparoscopic assisted total gastrectomy combined with D2 lymph node dissection in the treatment of upper and middle AGC.

From January 2012 to January 2017, 78 patients with upper and middle AGC were treated in our hospital retrospectively and divided into the laparoscopic assisted total gastrectomy group (LATG group) and open total gastrectomy group (OTG group) according to the different operation methods. All the clinical data were statistically analyzed by SPSS 20.0 software. Related indexes of intraoperative and postoperative recovery and visual analogue score of pain were expressed in the form of mean±standard deviation. T test was used for comparison between groups. The incidence of postoperative complications and the follow-up results were expressed in the form of chi-square test.

The intraoperative blood loss was significantly lower, the incision length was significantly smaller, and the first time of exhaust after operation was significantly lower in the LATG group than in the OTG group (P<0.05). The postoperative exhaust time, the recovering time of gastrointestinal function, the hospital stay and the visual analogue score of pain in 1 week and 1 month after operation were significantly lower (P<0.05). There were no significant difference in the operative time, the number of lymph node dissection, the incidence of postoperative complications and the overall survival rate in 1 year after operation (P>0.05).

The LATG combined with D2 lymph node dissection is safe and feasible for upper and middle AGC patients. At the same time, with less intraoperative bleeding, smaller incision, quicker recovery, no increase of complications, the number of lymph node dissection can be consistent with the open surgery, the short-term effect is more ideal, which is worth popularization in clinic.