Clinical study of laparoscopic D2 radical treatment of gastric cancer and paraaortic lymph node dissection in the treatment of locally advanced gastric cancer

doi:10.3877/cma.j.issn.1674-3946.2025.02.017.

Abstract

Abstract:

Objective

To investigate the clinical significance of laparoscopic D2 radical resection combined with paraaortic lymph node dissection (PAND) in the treatment of locally advanced gastric cancer.

Methods

Data of 61 patients with locally advanced gastric cancer from January 2022 to January 2024 were retrospectively analyzed.All patients underwent laparoscopic gastrectomy and were divided into two groups according to the scope of intraoperative lymph node dissection.32 patients in the control group underwent D2 lymph node dissection, and 29 patients in the observation group received ascending PAND on this basis.SPSS 26.0 was used for data statistics.Measurement data such as perioperative indexes were expressed with (x±s),and independent sample t test was performed.Postoperative complications and other statistical data were described by［cases (%)］, and χ² tests were performed.Survival curves were drawn by Kaplan-Meier, and survival conditions of the two groups were analyzed by Log-Rank test.P＜0.05 was considered statistically significant.

Results

The operation time and the number of lymph node dissection in observation group were significantly higher than those in control group (P＜0.05).There was no significant difference in the amount of blood loss, the time of drainage tube removal and the number of days in hospital between the two groups (P＞0.05).There was no significant difference in the incidence of complications between the observation group (15.6%)and the control group (10.0%) (P＞0.05).The cumulative overall survival rate of observation group was 86.2%,which was higher than that of control group (75.0%), but the difference was not statistically significant (P=0.317).

Conclusion

In patients with locally advanced gastric cancer, D2+PAND treatment can prolong the operation time, but more lymph nodes can be removed without increasing the risk of surgical complications, which is safe and feasible.

Key words: Stomach Neoplasm, Local Progressive Stage, Laparoscopic Gastrectomy, D2 Lymph Node Dissection, Para Aortic Lymph Nodes, Nano Carbon Tracer

Chongwen Deng, Xiwang Liao, Youxiong Shi, Jun Gong, Hong Zhong. Clinical study of laparoscopic D2 radical treatment of gastric cancer and paraaortic lymph node dissection in the treatment of locally advanced gastric cancer[J]. Chinese Journal of Operative Procedures of General Surgery(Electronic Edition), 2025, 19(02): 180-183.

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URL: https://zhpwkssxzz.cma-cmc.com.cn/EN/10.3877/cma.j.issn.1674-3946.2025.02.017.

https://zhpwkssxzz.cma-cmc.com.cn/EN/Y2025/V19/I02/180

Figures/Tables 4

组别	例数	性别（例）	年龄（岁， $\overset{ˉ}{x}$ ±s）	BMI（kg/m²， $\overset{ˉ}{x}$ ±s）
组别	例数	男/女	年龄（岁， $\overset{ˉ}{x}$ ±s）	BMI（kg/m²， $\overset{ˉ}{x}$ ±s）
观察组	29	13/16	59.9±6.3	22.3±1.4
对照组	32	17/15	60.4±6.1	22.5±1.6
χ ²/t值		0.419	0.315	0.517
P值		0.517	0.754	0.607
组别	例数	肿瘤直径（cm， $\overset{ˉ}{x}$ ±s）	TNM分期（例）	基础疾病（例）
组别	例数	肿瘤直径（cm， $\overset{ˉ}{x}$ ±s）	Ⅲ_a/Ⅲ_b	有/无
观察组	29	4.6±0.4	16/14	8/21
对照组	32	4.5±0.6	19/13	12/20
χ ²/t值		0.758	0.230	0.678
P值		0.452	0.632	0.410

组别	例数	性别（例）	年龄（岁， $\overset{ˉ}{x}$ ±s）	BMI（kg/m²， $\overset{ˉ}{x}$ ±s）
组别	例数	男/女	年龄（岁， $\overset{ˉ}{x}$ ±s）	BMI（kg/m²， $\overset{ˉ}{x}$ ±s）
观察组	29	13/16	59.9±6.3	22.3±1.4
对照组	32	17/15	60.4±6.1	22.5±1.6
χ ²/t值		0.419	0.315	0.517
P值		0.517	0.754	0.607
组别	例数	肿瘤直径（cm， $\overset{ˉ}{x}$ ±s）	TNM分期（例）	基础疾病（例）
组别	例数	肿瘤直径（cm， $\overset{ˉ}{x}$ ±s）	Ⅲ_a/Ⅲ_b	有/无
观察组	29	4.6±0.4	16/14	8/21
对照组	32	4.5±0.6	19/13	12/20
χ ²/t值		0.758	0.230	0.678
P值		0.452	0.632	0.410

组别	例数	手术时间（min）	术中出血量（ml）	淋巴结清扫数目（枚）
观察组	29	320.4±31.3	166.3±19.8	26.5±6.9
对照组	32	278.1±27.4	157.3±20.7	22.4±6.4
t值		5.628	1.731	2.408
P值		0.000	0.089	0.019
组别	例数	引流管拔除时间（d）	住院天数（d）
观察组	29	3.1±0.5	8.9±0.7
对照组	32	2.9±0.6	8.7±0.6
t值		1.406	1.201
P值		0.165	0.234

组别	例	感染	出血	淋巴漏	胸腔积液	吻合口狭窄	总发生率（%）
观察组	29	1	2	1	0	1	5（17.2）
对照组	32	1	1	0	1	1	4（12.5）
χ ²值		-	-	-	-	-	0.272
P值		-	-	-	-	-	0.873

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