To investigate the effect of 3D laparoscopic proximal radical gastrectomy in patients with T3-4 gastric cancer >5 cm in diameter.

Clinical data of 36 patients with advanced gastric cancer receiving 3D laparoscopic radical proximal gastrectomy from January 2019 to June 2020 (3D group) were retrospectively analyzed, and 40 patients (2D group) receiving 2D laparoscopic radical proximal gastrectomy during the same period were selected. SPSS 22.00 statistical software was used for data analysis. Measurement data such as the number and time of splenic lymph nodes dissected were expressed as (±s). Independent sample t test was performed. The incidence of complications were tested by χ² test. P<0.05 was considered statistically significant.

The operative time, intraoperative blood loss, the number of splenic hilar lymph nodes dissection, the time of splenic hilar lymph nodes dissection and the incidence of accidental spleen injury in the 3D group were lower than those in the 2D group, with statistical significance (P<0.05). In both groups, there was no complete splenic infarction. In the 3D group, intraoperative splenic hilar hemorrhage occurred in 1 case, local splenic infarction in 1 case, and accidental injury to the spleen in 2 cases. In group 2D, there were 3 cases of splenic hilar hemorrhage, 5 cases of local splenic infarction, and 9 cases of accidental splenic injury. There were no significant differences in intraoperative splenic portal hemorrhage and local spleen infarction between the two groups (P>0.05). The incidence of accidental spleen injury in the 3D group was significantly lower than that in the 2D group (P<0.05). The incidence of complications was 8.3% in the 3D group and 15.0% in the 2D group, and there was no significant difference between the two groups (P>0.05). The follow-up time was 6 to 18 months, and the median follow-up time was 9 months. In the 3D group, the follow-up rate was 100%, with 1 recurrence and no death. In the follow-up of 38 patients in the 2D group, 2 patients recurred and 1 died of liver metastasis. There was no significant difference in the recurrence and metastasis rate and postoperative survival rate between the two groups (P>0.05).

In radical resection of proximal gastric cancer, 3D laparoscopy can shorten the operation time, reduce intraoperative blood loss, more complete splenic hilar lymph node dissection and reduce the possibility of spleen injury. The method is safe and reliable, and the prognosis is good in the near future.