Clinical comparison of hand assisted laparoscopic gastrectomy with laparotomy and laparoscopy assisted radical gastrectomy for distal gastric cancer

doi:10.3877/cma.j.issn.1674-0785.2018.04.005

Abstract

Abstract:

Objective

To evaluate the value of hand assisted laparoscopic radical resection for distal gastric cancer.

Methods

The clinical data of 80 patients with advanced gastric cancer from August 2015 to December 2017 were retrospectively analyzed. Among them, 30 patients underwent hand-assisted laparoscopic surgery, 25 patients underwent open surgery, and 25 patients underwent laparoscopic assisted surgery. The operative time, bleeding volume, number of recected lymph nodes, time to postoperative exhaust, postoperative complications, length of hospitalization, hospitalization expenses, length of incision and so on were compared among the three groups. The data were analyzed with SPSS 21.0 software. Measurement data are expressed as mean±standard deviation. ANOVA was used to compare measurement data, and the chi square test or Fisher exact test was used to compare count data. P<0.05 indicated that the difference was statistically significant.

Results

There was no significant difference in the number of recected lymph nodes, postoperative hospitalization expenses, or postoperative complications among the three groups (P>0.05). The hand-assisted laparoscopic surgery group, laparoscopy assisted surgery group, and open surgery group had significantly different operative time [(186.30±15.27) min vs (230.80±17.06) min vs (183.36±16.03) min] , intraoperative bleeding volume [(93.33±46.86) mL vs (98.80±55.10) mL vs (246.80±92.90) mL] , time to postoperative exhaust [(2.3±0.6) d vs (2.42±0.44) d vs (3.04±0.56) d] , length of stay [(8.90±1.19) d vs (9.40±1.44) d vs (10.92±1.73) d] , and incision length [(7.97±0.49) cm vs (8.04±0.61) cm vs (24.04±2.11) cm] (P<0.001 for all). The length of incision, blood loss, time to postoperative exhaust, and hospital stay were significantly lower in the hand-assisted laparoscopic operation group and laparoscopically assisted operation group than in the open operation group (P<0.001). The operative time was significantly shorter in the hand-assisted laparoscopic surgery group and laparotomy group than in the laparoscopically assisted operation group (P<0.001).

Conclusion

Hand assisted laparoscopic distal gastrectomy is safe and feasible, can achieve the radical effect of open surgery for tumor resection and lymph node dissection, and does not increase the economic burden of patients. Hand assisted laparoscopic surgery has the advantages of less intraoperative bleeding, faster postoperative recovery, and shorter operative time than laparoscopic assisted surgery.

Key words: Hand assisted laparoscopy, Laparoscopy assisted, Traditional laparotomy, Advanced gastric cancer

Zhanxue Zhang, Zhong Li, Haiqiang Zhang, Shaofan Qiu, Haijun Wang, Lina Ru, Zhanwen Wang, Tao Li. Clinical comparison of hand assisted laparoscopic gastrectomy with laparotomy and laparoscopy assisted radical gastrectomy for distal gastric cancer[J]. Chinese Journal of Clinicians(Electronic Edition), 2018, 12(04): 212-217.

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Figures/Tables 5

References 23

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组别	例数	性别（例，男/女）	年龄（岁，±s）	肿瘤大小（cm，±s）	病理类型（例，腺癌/印戒/黏液腺）	腹主动脉旁有肿大淋巴结（例）	腹部手术史（例）
HALS组	30	17/13	57.90±9.54	4.28±1.41	25/4/1	2	1
OS组	25	15/10	57.00±8.90	4.86±1.33	22/2/1	3	2
LAS组	25	14/11	58.56±7.59	4.12±1.42	21/2/2	1	1
统计值	?	χ²=0.095	F=0.200	F=1.992	-	-	-
P值	?	0.953	0.820	0.143	0.883	0.667	0.828

组别	例数	性别（例，男/女）	年龄（岁，±s）	肿瘤大小（cm，±s）	病理类型（例，腺癌/印戒/黏液腺）	腹主动脉旁有肿大淋巴结（例）	腹部手术史（例）
HALS组	30	17/13	57.90±9.54	4.28±1.41	25/4/1	2	1
OS组	25	15/10	57.00±8.90	4.86±1.33	22/2/1	3	2
LAS组	25	14/11	58.56±7.59	4.12±1.42	21/2/2	1	1
统计值	?	χ²=0.095	F=0.200	F=1.992	-	-	-
P值	?	0.953	0.820	0.143	0.883	0.667	0.828

组别	例数	手术时间（h，±s）	出血量（ml，±s）	清扫淋巴结数（个，±s）	术后排气时间（d，±s）	术后并发症［例（%）］	住院时间（d，±s）	住院费用（元，±s）	切口长度（cm，±s）
HALS组	30	186.30±15.27	93.33±46.86	24.73±2.46	2.30±0.6	2（6.6）	8.90±1.19	58174.77±7278.50	7.97±0.49
LAS组	25	230.80±17.06	98.80±55.10	27.8±6.9	2.24±0.41	3（12）	9.40±1.44	61572.48±5393.24	8.04±0.61
OS组	25	183.36±16.03	246.80±92.90	25.08±2.02	3.04±0.56	5（20）	10.92±1.73	56535.92±10326.71	24.04±2.11
F（χ²）值	?	70.055	43.937	0.387	20.162	2.160	13.892	2.663	1385.430
P值	?	<0.001	<0.001	0.680	<0.001	0.369	<0.001	0.076	<0.001
P_a值	?	0.777	<0.001	>0.05	<0.001	-	<0.001	>0.05	<0.001
P_b值	?	<0.001	0.955	>0.05	0.387	-	0.450	>0.05	0.977
P_c值	?	<0.001	<0.001	>0.05	<0.001	-	<0.001	>0.05	<0.001

组别	例数	手术时间（h，±s）	出血量（ml，±s）	清扫淋巴结数（个，±s）	术后排气时间（d，±s）	术后并发症［例（%）］	住院时间（d，±s）	住院费用（元，±s）	切口长度（cm，±s）
HALS组	30	186.30±15.27	93.33±46.86	24.73±2.46	2.30±0.6	2（6.6）	8.90±1.19	58174.77±7278.50	7.97±0.49
LAS组	25	230.80±17.06	98.80±55.10	27.8±6.9	2.24±0.41	3（12）	9.40±1.44	61572.48±5393.24	8.04±0.61
OS组	25	183.36±16.03	246.80±92.90	25.08±2.02	3.04±0.56	5（20）	10.92±1.73	56535.92±10326.71	24.04±2.11
F（χ²）值	?	70.055	43.937	0.387	20.162	2.160	13.892	2.663	1385.430
P值	?	<0.001	<0.001	0.680	<0.001	0.369	<0.001	0.076	<0.001
P_a值	?	0.777	<0.001	>0.05	<0.001	-	<0.001	>0.05	<0.001
P_b值	?	<0.001	0.955	>0.05	0.387	-	0.450	>0.05	0.977
P_c值	?	<0.001	<0.001	>0.05	<0.001	-	<0.001	>0.05	<0.001

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