Comparison of total laparoscopic and laparoscopic assisted radical gastrectomy in the treatment of advanced gastric cancer in the near and medium term

doi:10.3877/cma.j.issn.1674-3946.2025.01.008.

Abstract

Abstract:

Objective

To investigate the short-term and medium-term effects of total laparoscopic radical gastrectomy （TLDG） and laparoscopic assisted radical gastrectomy （LADG） in the treatment of advanced gastric cancer.

Method

A total of 120 patients with advanced gastric cancer from March 2020 to February 2022 were selected and randomly divided into LADG group and TLDG group according to numerical table method， with 60 patients in each group.Data were processed by SPSS 25.0 software.Measurement data such as perioperative indicators were represented by （x ± s） and M（P₂₅， P₇₅）.Independent sample t and non-parametric Mann-Whitney U test were used.The complication rate within 30d and recurrence rate within 2 years were tested by χ² test.The recurrence time was tested by Log-Rank.P＜0.05 indicated that the difference was statistically significant.

Results

The amount of intraoperative blood loss， first exhaust time and hospital stay in TLDG group were lower than those in LADG group （P＜0.05）.There was no significant difference in other perioperative indexes （P＞0.05）.There was no significant difference in complications within 30d， recurrence rate within 2 years and recurrence time between the two groups （P＞0.05）.

Conclusion

The near and medium-term follow-up results of TLDG and LADG in the treatment of advanced gastric cancer are comparable.Compared with LADG， TLDG can relatively reduce the amount of intraoperative blood loss， promote the rapid recovery of postoperative gastrointestinal function， and shorten the length of hospital stay.

Key words: Stomach Neoplasms, Total Laparoscopic Distal Gastric Rectomy, Laparoscopy-Assisted Distal Gastrectomy, Postoperative Complications, Recurrence

Liuqing Li, Xiaoxiang Chen, Chengyu Lv. Comparison of total laparoscopic and laparoscopic assisted radical gastrectomy in the treatment of advanced gastric cancer in the near and medium term[J]. Chinese Journal of Operative Procedures of General Surgery(Electronic Edition), 2025, 19(01): 23-26.

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Figures/Tables 5

组别	例数	年龄（岁， $\overset{ˉ}{x}$ ±s）	性别（例）男/女	BMI（kg/m²，ˉ±）	TNM分期（例）I_b/II/III
TLDG组	60	58.3±8.3	48/12	25.5±2.3	13/17/30
LADG组	60	60.3±6.7	43/17	26.2±2.3	7/20/33
t/χ²值		1.454	1.137	1.575	1.155
P值		0.149	0.286	0.118	0.248

组别	例数	年龄（岁， $\overset{ˉ}{x}$ ±s）	性别（例）男/女	BMI（kg/m²，ˉ±）	TNM分期（例）I_b/II/III
TLDG组	60	58.3±8.3	48/12	25.5±2.3	13/17/30
LADG组	60	60.3±6.7	43/17	26.2±2.3	7/20/33
t/χ²值		1.454	1.137	1.575	1.155
P值		0.149	0.286	0.118	0.248

组别	例数	手术时间（min， $\overset{ˉ}{x}$ ±s）	术中出血量（ml， $\overset{ˉ}{x}$ ±s）	首次排气时间（h， $\overset{ˉ}{x}$ ±s）	胃管拔除时间［d，M（P₂₅，P₇₅）］
TLDG组	60	218.3±22.7	68.6±8.5	48.2±6.8	3.0（3.0，4.0）
LADG组	60	225.4±20.8	81.4±9.2	50.8±6.2	3.0（3.0，4.0）
t/Z值		1.772	7.845	2.188	1.347
P值		0.079	＜0.001	0.031	0.178
组别	例数	住院时间［d，M（P₂₅，P₇₅）］	近端切缘距离（cm， $\overset{ˉ}{x}$ ±s）	远端切缘距离（cm， $\overset{ˉ}{x}$ ±s）	淋巴结清扫数目（枚， $\overset{ˉ}{x}$ ±s）
TLDG组	60	7.0（6.0，8.0）	4.4±0.5	4.2±0.5	33.6±6.6
LADG组	60	10.0（9.0，10.0）	4.2±0.4	4.4±0.5	31.6±6.8
t/Z值		6.091	1.364	1.893	1.586
P值		＜0.001	0.175	0.061	0.115

组别	例数	手术时间（min， $\overset{ˉ}{x}$ ±s）	术中出血量（ml， $\overset{ˉ}{x}$ ±s）	首次排气时间（h， $\overset{ˉ}{x}$ ±s）	胃管拔除时间［d，M（P₂₅，P₇₅）］
TLDG组	60	218.3±22.7	68.6±8.5	48.2±6.8	3.0（3.0，4.0）
LADG组	60	225.4±20.8	81.4±9.2	50.8±6.2	3.0（3.0，4.0）
t/Z值		1.772	7.845	2.188	1.347
P值		0.079	＜0.001	0.031	0.178
组别	例数	住院时间［d，M（P₂₅，P₇₅）］	近端切缘距离（cm， $\overset{ˉ}{x}$ ±s）	远端切缘距离（cm， $\overset{ˉ}{x}$ ±s）	淋巴结清扫数目（枚， $\overset{ˉ}{x}$ ±s）
TLDG组	60	7.0（6.0，8.0）	4.4±0.5	4.2±0.5	33.6±6.6
LADG组	60	10.0（9.0，10.0）	4.2±0.4	4.4±0.5	31.6±6.8
t/Z值		6.091	1.364	1.893	1.586
P值		＜0.001	0.175	0.061	0.115

组别	例数	感染	吻合口漏	吻合口出血
TLDG组	60	3（5.0）	1（1.7）	0（0.0）
LADG组	60	1（1.7）	1（1.7）	2（3.3）
χ²值		0.259	0.509	0.509
P值		0.611	0.476	0.476
组别	例数	吻合口狭窄	胃瘫	肠梗阻
TLDG组	60	1（1.7）	2（3.3）	2（3.3）
LADG组	60	0（0.0）	5（8.3）	4（6.7）
χ²值		0.000	0.607	0.175
P值		1.000	0.436	0.675

组别	例数	复发（例）		中位复发时间［月，M（P₂₅，P₇₅）］
组别	例数	是/	否	中位复发时间［月，M（P₂₅，P₇₅）］
TLDG组	60	32/	28	16.0（14.4，17.6）
LADG组	60	37/	23	16.0（13.5，18.6）
Log-Rank/χ²值		0.853		2.033
P值		0.356		0.154

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