Comparison of the efficacy of radical laparoscopic total gastrectomy in the treatment of overweight gastric cancer with two approaches

doi:10.3877/cma.j.issn.1674-3946.2025.01.007.

Abstract

Abstract:

Objective

To compare the efficacy of laparoscopic radical gastrectomy （TLTG） with two different approaches in the treatment of overweight gastric cancer.

Methods

Clinical data of 105 patients with overweight gastric cancer who received TLTG from January 2019 to May 2023 and completed 2-year follow-up were retrospectively analyzed， and they were divided into left approach group （n=52 cases） and right approach group （n=53 cases） according to different surgical approaches.The data were analyzed with SPSS 25.0 software， and the measurement data such as perioperative indicators were expressed as （x± s ）， and independent sample t test was performed.The count data were represented by ［cases （%）］ and χ² test was performed.Disease recurrence and survival were analyzed by Kaplan-Meier curve.P＜0.05 was considered statistically significant.

Results

Compared with the left approach group， the right approach group had shorter operation time， less intraoperative blood loss， more lymph node dissection， shorter time for first anal exhaust and first getting out of bed， fewer disease recurrence cases within 2 years after surgery， and longer tumor free survival （P＜0.05）.There was no significant difference in postoperative complications， 2-year postoperative survival and overall survival between the two groups （P＞0.05）.

Conclusion

The safety and short-term survival of TLTG in the treatment of overweight gastric cancer under the two approaches are comparable.However， compared with the left approach，the right approach has shorter operation time， less intraoperative bleeding， more intraoperative lymph node dissection， faster postoperative recovery， and relatively fewer cases of disease recurrence 2 years after surgery.

Key words: Stomach Neoplasms, Overweight, Laparoscopes, Gastrectomy, Approach, Prognosis

Jie Xu, Yajun Li, Junwei Han. Comparison of the efficacy of radical laparoscopic total gastrectomy in the treatment of overweight gastric cancer with two approaches[J]. Chinese Journal of Operative Procedures of General Surgery(Electronic Edition), 2025, 19(01): 19-22.

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URL: https://zhpwkssxzz.cma-cmc.com.cn/EN/10.3877/cma.j.issn.1674-3946.2025.01.007.

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Figures/Tables 7

组别	例数	年龄（岁， $\overset{ˉ}{x}$ ±s）	性别（例）男/女	体重指数（kg/m²， $\overset{ˉ}{x}$ ±s）	肿瘤位置（例）A/B	肿瘤分期（例）Ⅱ/Ⅲ
左侧入路组	52	58.2±5.4	33/19	26.0±0.9	29/23	35/17
右侧入路组	53	58.4±5.2	31/22	26.0±0.8	26/27	33/20
t/χ²值		0.123	0.273	0.096	0.474	0.293
P值		0.902	0.602	0.924	0.491	0.589

组别	例数	年龄（岁， $\overset{ˉ}{x}$ ±s）	性别（例）男/女	体重指数（kg/m²， $\overset{ˉ}{x}$ ±s）	肿瘤位置（例）A/B	肿瘤分期（例）Ⅱ/Ⅲ
左侧入路组	52	58.2±5.4	33/19	26.0±0.9	29/23	35/17
右侧入路组	53	58.4±5.2	31/22	26.0±0.8	26/27	33/20
t/χ²值		0.123	0.273	0.096	0.474	0.293
P值		0.902	0.602	0.924	0.491	0.589

组别	例数	手术时间（min）	术中出血量（ml）	淋巴结清扫数目（枚）
左侧入路组	52	252.2±16.7	81.7±6.5	32.3±3.1
右侧入路组	53	228.2±15.3	75.2±5.3	34.2±3.4
t值		7.677	5.574	3.002
P值		＜0.001	＜0.001	0.003

组别	例数	首次肛门排气时间	首次下床活动时间	引流管拔除时间	住院时间
左侧入路组	52	3.94±0.50	2.85±0.36	4.12±0.54	10.44±1.11
右侧入路组	53	3.60±0.49	2.25±0.43	4.04±0.39	10.62±1.57
t值		3.485	7.673	0.838	0.678
P值		＜0.001	＜0.001	0.404	0.103

组别	例数	切口感染	肠梗阻	肺部感染	吻合口出血	总并发症
左侧入路组	52	1（1.9）	1（1.9）	1（1.9）	2（3.8）	5（9.6）
右侧入路组	53	1（1.9）	0（0.0）	1（1.9）	1（1.9）	3（5.7）
t值		-	-	-	-	0.157
P值		-	-	-	-	0.692

组别	例	复发（例）	生存（例）	无瘤生存期（月， $\overset{ˉ}{x}$ ±s）	总生存期（月， $\overset{ˉ}{x}$ ±s）
左侧入路组	52	18	42	20.6±5.3	22.9±2.6
右侧入路组	53	9	47	22.9±2.5	23.6±1.1
t/χ²值		4.273	0.342	2.866	1.705
P值		0.039	0.559	0.005	0.091

组别	例	复发（例）	生存（例）	无瘤生存期（月， $\overset{ˉ}{x}$ ±s）	总生存期（月， $\overset{ˉ}{x}$ ±s）
左侧入路组	52	18	42	20.6±5.3	22.9±2.6
右侧入路组	53	9	47	22.9±2.5	23.6±1.1
t/χ²值		4.273	0.342	2.866	1.705
P值		0.039	0.559	0.005	0.091

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