Clinical study on laparoscopic D2 radical surgery combined with total mesocolic excision for advanced gastric cancer

doi:10.3877/cma.j.issn.1674-3946.2026.06.011

Abstract

Abstract:

Objective

To investigate the clinical efficacy and safety of laparoscopic distal gastrectomy with D2 resection combined with total mesorectal excision (TME) in patients with advanced gastric cancer.

Methods

A retrospective cohort study was conducted on 253 cases of advanced gastric cancer admitted to our hospital from March 2019 to March 2023. The patients were grouped according to the surgical method. 121 patients underwent laparoscopic distal gastrectomy with D2 resection combined with TME and were included in group A, while 132 patients underwent laparoscopic distal gastrectomy and were included in group B. The data of the two groups were matched by propensity score, and finally 106 pairs of matched cases were obtained. Quantitative data that followed a normal distribution were expressed as (

x ¯

±s), and the differences between the groups were analyzed by independent sample t test; the differences in count data such as complication rates were analyzed by χ² test; survival outcomes were plotted using the Kaplan-Meier method, and the differences in survival conditions between the groups were analyzed using the Log-Rank test.

Results

Compared with group B, group A had shorter operation time, less intraoperative blood loss, and more regional lymph node dissections (P<0.05); there was no statistically significant difference in R0 resection rate between the two groups (P>0.05). The time to anal exhaust, first meal intake, abdominal drainage, and postoperative hospital stay in group A were shorter than those in group B (P<0.05). Stratified analysis of reconstruction methods showed that there was no statistically significant difference in the incidence of complications among different reconstruction methods within groups A and B (P>0.05). The incidence of incision infection, abdominal infection, and gastrointestinal dysfunction in group A was lower than that in group B (P<0.05). There was no statistically significant difference in the incidence of anastomotic leakage, anastomotic bleeding, and intestinal obstruction between the two groups (P>0.05). The 1-year and 3-year disease-free survival rate and overall survival rate of group A were higher than those of group B, and the disease-free survival period and overall survival period of group A were also longer than those of group B (P<0.05). The recurrence rate of group A was lower than that of group B at 1 year and 3 years (P<0.05).

Conclusion

For patients with advanced gastric cancer, laparoscopic distal gastrectomy with D2 resection combined with TME can optimize perioperative indicators, accelerate the postoperative recovery process, reduce the risk of some complications, and improve survival prognosis.

Key words: Stomach Neoplasms, Laparoscopes, Total Mesogastric Excision, Postoperative Complications, Recurrence

Huazhi Li, Haitao Sun, Yajing Zhang, Guang Cao. Clinical study on laparoscopic D2 radical surgery combined with total mesocolic excision for advanced gastric cancer[J]. Chinese Journal of Operative Procedures of General Surgery(Electronic Edition), 2026, 20(06): 551-557.

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URL: https://zhpwkssxzz.cma-cmc.com.cn/EN/10.3877/cma.j.issn.1674-3946.2026.06.011

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Figures/Tables 9

组别	例数	性别（例）		年龄（岁， $x ¯$ ±s）	身体质量指数（kg/m²， $x ¯$ ±s）	胃癌家族史（例）	肿瘤位置（例）
组别	例数	男	女	年龄（岁， $x ¯$ ±s）	身体质量指数（kg/m²， $x ¯$ ±s）	胃癌家族史（例）	A	B	C
A组	106	66	40	61.4±8.4	22.5±2.9	15	38	35	33
B组	106	70	36	62.2±9.2	23.0±3.1	12	36	40	30
统计值		χ²=0.328		t=0.674	t=1.123	χ²=0.382	χ²=0.530
P值		0.567		0.501	0.263	0.537	0.767
组别	分化程度（例）		肿瘤最大径（cm， $x ¯$ ±s）	TNM分期（例）		CEA（ng/ml， $x ¯$ ±s）	CA19-9（U/ml， $x ¯$ ±s）
组别	中高	低	肿瘤最大径（cm， $x ¯$ ±s）	Ⅱ	Ⅲ	CEA（ng/ml， $x ¯$ ±s）	CA19-9（U/ml， $x ¯$ ±s）
A组	75	31	4.5±0.4	34	72	8.9±2.1	40.6±5.4
B组	72	34	4.8±0.6	30	76	9.1±2.3	39.6±5.8
统计值	χ²=0.200		t=1.768	χ²=0.358		t=0.890	t=1.173
P值	0.655		0.079	0.550		0.375	0.242

组别	例数	性别（例）		年龄（岁， $x ¯$ ±s）	身体质量指数（kg/m²， $x ¯$ ±s）	胃癌家族史（例）	肿瘤位置（例）
组别	例数	男	女	年龄（岁， $x ¯$ ±s）	身体质量指数（kg/m²， $x ¯$ ±s）	胃癌家族史（例）	A	B	C
A组	106	66	40	61.4±8.4	22.5±2.9	15	38	35	33
B组	106	70	36	62.2±9.2	23.0±3.1	12	36	40	30
统计值		χ²=0.328		t=0.674	t=1.123	χ²=0.382	χ²=0.530
P值		0.567		0.501	0.263	0.537	0.767
组别	分化程度（例）		肿瘤最大径（cm， $x ¯$ ±s）	TNM分期（例）		CEA（ng/ml， $x ¯$ ±s）	CA19-9（U/ml， $x ¯$ ±s）
组别	中高	低	肿瘤最大径（cm， $x ¯$ ±s）	Ⅱ	Ⅲ	CEA（ng/ml， $x ¯$ ±s）	CA19-9（U/ml， $x ¯$ ±s）
A组	75	31	4.5±0.4	34	72	8.9±2.1	40.6±5.4
B组	72	34	4.8±0.6	30	76	9.1±2.3	39.6±5.8
统计值	χ²=0.200		t=1.768	χ²=0.358		t=0.890	t=1.173
P值	0.655		0.079	0.550		0.375	0.242

组别	例数	手术时间（min， $x ¯$ ±s）	术中出血量（ml， $x ¯$ ±s）	区域淋巴结清扫数目（枚， $x ¯$ ±s）	R0切除[例（%）]
A组	106	185.4±22.7	88.6±15.2	28.7±5.4	102(96.2)
B组	106	208.6±25.4	105.3±18.7	25.2±4.9	100(94.3)
统计值		t=7.080	t=7.147	t=4.827	χ²=0.420
P值		<0.001	<0.001	<0.001	0.517

组别	例数	手术时间（min， $x ¯$ ±s）	术中出血量（ml， $x ¯$ ±s）	区域淋巴结清扫数目（枚， $x ¯$ ±s）	R0切除[例（%）]
A组	106	185.4±22.7	88.6±15.2	28.7±5.4	102(96.2)
B组	106	208.6±25.4	105.3±18.7	25.2±4.9	100(94.3)
统计值		t=7.080	t=7.147	t=4.827	χ²=0.420
P值		<0.001	<0.001	<0.001	0.517

组别	例数	肛门排气时间	首次进食时间	腹腔引流时间	术后住院时间
A组	106	2.6±0.7	3.6±0.9	5.2±1.3	10.4±2.4
B组	106	3.3±0.9	4.3±1.1	6.3±1.9	12.7±3.2
t值		6.300	4.613	5.172	6.039
P值		<0.001	<0.001	<0.001	<0.001

组别	例数	切口感染	腹腔感染	吻合口漏	吻合口出血	胃肠功能紊乱	肠梗阻
Billroth I组	52	1(1.9)	1(1.9)	0	1(1.9)	1(1.9)	1(1.9)
Roux-en-Y组	32	1(3.1)	0	1(3.1)	0	2(6.2)	1(3.1)
Billroth Ⅱ组	22	1(4.5)	1(4.5)	2(9.1)	1(4.5)	1(4.5)	0
统计值		-	-	-	-	-	-
P值		0.780	0.463	0.072	0.463	0.537	1.000

组别	例数	切口感染	腹腔感染	吻合口漏	吻合口出血	胃肠功能紊乱	肠梗阻
BillrothⅡ+Braun组	69	8(11.6)	6(8.7)	4(5.8)	3(4.3)	7(10.1)	2(2.9)
Roux-en-Y组	37	4(10.8)	3(8.1)	1(2.7)	1(2.7)	5(13.5)	1(2.7)
统计值		-	-	-	-	-	-
P值		1.000	1.000	0.656	1.000	0.749	1.000

组别	例数	切口感染	腹腔感染	吻合口漏	吻合口出血	胃肠功能紊乱	肠梗阻
A组	106	3(2.8)	2(1.9)	3(2.8)	2(1.9)	4(3.8)	2(1.9)
B组	106	12(11.3)	9(8.5)	5(4.7)	4(3.8)	12(11.3)	3(2.8)
χ²值		5.811	4.698	-	-	4.327	-
P值		0.016	0.030	0.721	0.683	0.038	1.000

组别	例数	1年无进展生存	1年总生存	3年无进展生存	3年总生存
A组	106	99(93.4)	102(96.2)	82(77.4)	89(84.0)
B组	106	89(84.0)	94(88.7)	68(64.2)	75(70.8)
χ²值		4.699	4.327	4.468	5.279
P值		0.030	0.038	0.035	0.022

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